Disparity in ST-segment Elevation Myocardial Infarction Practices and Outcomes in Arabian Gulf Countries (Gulf COAST
Mohammad Zubaid1, Wafa Rashed2, Alawi A Alsheikh-Ali3,4
1Department of Medicine, Faculty of Medicine, Kuwait University, Kuwait.
Insights
Management of ST-segment elevation myocardial infarction (STEMI) in Gulf countries relies heavily on fibrinolytic therapy, often not meeting guideline timelines. Significant outcome disparities exist between countries, necessitating quality improvement initiatives.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- ST-segment elevation myocardial infarction (STEMI) is a critical cardiovascular emergency.
- Contemporary management strategies and outcomes for STEMI patients in the Arabian Gulf region require detailed examination.
Purpose of the Study:
- To describe the current management approaches for STEMI patients hospitalized in Arabian Gulf countries.
- To evaluate the 1-year outcomes of these patients.
- To identify variations in management and outcomes across different Gulf nations.
Main Methods:
- Analysis of data from the Gulf COAST registry, a longitudinal, observational study.
- Inclusion of consecutive citizens diagnosed with STEMI admitted to 29 hospitals in Bahrain, Kuwait, Oman, and the UAE between January 2012 and January 2013.
- Comparison of patient management and outcomes across the four participating countries.
Main Results:
- A total of 1039 STEMI patients were analyzed, with a mean age of 58 years and a high prevalence of diabetes (47%).
- Fibrinolytic therapy was the primary reperfusion strategy (66%), followed by primary percutaneous coronary intervention (10%), with 24% receiving no reperfusion.
- Door-to-needle times for fibrinolytic therapy were suboptimal in most cases (only one-third within 30 minutes), and in-hospital mortality was 7.4% with significant regional variation (3.8%-11.9%). Patients from Oman had a fourfold higher in-hospital mortality risk compared to Kuwait.
Conclusions:
- Fibrinolytic therapy is the predominant reperfusion strategy for STEMI in the Gulf countries, but adherence to guideline timelines is poor.
- Substantial disparities in in-hospital mortality rates exist among the Gulf countries studied.
- Urgent quality improvement initiatives are essential to enhance adherence to STEMI management guidelines and reduce outcome gaps.
Objectives:
The objective of this study is to describe contemporary management and 1-year outcomes of patients hospitalized with ST-segment elevation myocardial infarction (STEMI) in Arabian Gulf countries.
Methods:
Data of patients admitted to 29 hospitals in four Gulf countries [Bahrain, Kuwait, Oman, United Arab Emirates (UAE)] with the diagnosis of STEMI were analyzed from Gulf locals with acute coronary syndrome (ACS) events (Gulf COAST) registry. This was a longitudinal, observational registry of consecutive citizens, admitted with ACS from January 2012 to January 2013. Patient management and outcomes were analyzed and compared between the four countries.
Results:
A total of 1039 STEMI patients were enrolled in Gulf COAST Registry. The mean age was 58 years, and there was a high prevalence of diabetes (47%). With respect to reperfusion, 10% were reperfused with primary percutaneous coronary intervention, 66% with fibrinolytic therapy and 24% were not reperfused. Only one-third of patients who received fibrinolytic therapy had a door-to-needle time of 30 min or less. The in-hospital mortality rate was 7.4%. However, we noted a significant regional variability in mortality rate (3.8%-11.9%). In adjusted analysis, patients from Oman were 4 times more likely to die in hospital as compared to patients from Kuwait.
Conclusions:
In the Gulf countries, fibrinolytic therapy is the main reperfusion strategy used in STEMI patients. Most patients do not receive this therapy according to timelines outlined in recent practice guidelines. There is a significant discrepancy in outcomes between the countries. Quality improvement initiatives are needed to achieve better adherence to management guidelines and close the gap in outcomes.
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