Primary coronary intervention versus thrombolytic therapy in myocardial infarction patients in the Middle East
Ibrahim Al-Zakwani1, Mohammad Zubaid, Adil Al-Riyami
1Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, P.O. Box 38, Al-Khodh, Muscat, 123, Sultanate of Oman. ial_zakwani@yahoo.com
Insights
Primary percutaneous coronary intervention (PPCI) is more effective than thrombolytic therapy (TT) for ST-segment elevation myocardial infarction (STEMI) patients in the Middle East, significantly reducing recurrent ischemic events.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Limited data exists on predictors and outcomes of primary percutaneous coronary intervention (PPCI) versus thrombolytic therapy (TT) for ST-segment elevation myocardial infarction (STEMI) in the Middle East.
- Understanding these differences is crucial for optimizing patient care in the region.
Purpose of the Study:
- To compare the predictors and in-hospital outcomes of PPCI and TT in STEMI patients across six Middle Eastern countries.
- To identify factors associated with the choice of reperfusion strategy.
Main Methods:
- A prospective, multinational, multicenter observational survey conducted in 65 hospitals across Oman, UAE, Qatar, Bahrain, Kuwait, and Yemen.
- Data collected from consecutive acute coronary syndrome patients admitted between May 2006-June 2006 and January 2007-June 2007 as part of the Gulf RACE registry.
- Statistical analyses included univariate and multivariate techniques to assess predictors and outcomes.
Main Results:
- Out of 2,155 STEMI patients, 92% received reperfusion, predominantly TT (84%) over PPCI (8%).
- Predictors for PPCI included prior PCI, presence of catheterization labs, and academic affiliation of hospitals.
- PPCI was associated with a significantly lower likelihood of recurrent ischemic attacks compared to TT (OR, 0.18; P=0.003).
Conclusions:
- Thrombolytic therapy remains the primary reperfusion strategy for STEMI in the Arab Middle East.
- Prior PCI, catheterization laboratory availability, and hospital academic status predict PPCI utilization.
- PPCI demonstrated superior outcomes in reducing recurrent ischemic events compared to TT in this cohort.
Background:
Little is known about predictors and outcome differences of primary percutaneous coronary intervention (PPCI) and thrombolytic therapy (TT) in ST-segment elevation myocardial infarction (STEMI) patients in the Middle East.
Objective:
To compare predictors as well as in-hospital outcomes of PPCI and TT in STEMI patients in six Middle Eastern countries.
Setting:
Sixty-five hospitals (covering at least 85 % of the population) in Oman, United Arab Emirates, Qatar, Bahrain, Kuwait and Yemen.
Methods:
This was a prospective, multinational, multicentre, observational survey of consecutive acute coronary syndrome patients who were admitted to 65 hospitals during May 8, 2006 to June 6, 2006 and from January 29, 2007 to June 29, 2007, as part of Gulf RACE (Registry of Acute Coronary Events). Analyses were performed using univariate and multivariate statistical techniques.
Main Outcome Measures:
Predictors as well as in-hospital outcomes of PPCI and TT in STEMI patients.
Results:
Out of 2,155 STEMI patients admitted to hospitals within 12 h of symptoms onset, 92 % received reperfusion (8 % PPCI and 84 % TT). TT use included reteplase (43 %), tenecteplase (30 %), streptokinase (25 %), and alteplase (2 %). Median age of the study cohort was 50 (44-58) years with majority being males (90 %). There were no significant differences in median onset time to presentation between the TT and PPCI groups (130 vs. 120 min; P = 0.422). Median door-to-needle time and door-to-balloon time were 45 min (29-75) and 75 min (58-120), respectively. Predictors of PPCI included prior PCI, hospitals with catheterization laboratory facilities as well as those involved with academia. Multivariate logistic regression model demonstrated that patients that had PPCI were less likely to have recurrent ischemic attacks than those that had TT (odds ratio, 0.18; 95 % CI, 0.06-0.56; P = 0.003).
Conclusions:
The main reperfusion strategy for STEMI patients in the Arab Middle East region is thrombolytic therapy. Predictors of primary percutaneous coronary intervention included prior percutaneous coronary intervention, hospitals with catheterization laboratory facilities as well as those involved with academia. Primary percutaneous coronary intervention resulted in significant reductions in recurrent ischemic events when compared to thrombolytic therapy.
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:27Coronary Artery Disease V: Interprofessional Care
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:27Peripheral Artery Disease III: Interprofessional Care
01:26Angina IV: Management