Differences in coronary disease severity at time of acute coronary syndrome between Middle East and North America

Comparing angiographic findings of patients presenting with acute coronary syndrome (ACS) in the Middle East/Gulf (MEG) and North America (NA) may shed light onto how coronary artery disease (CAD) complexity at time of ACS presentation impacts immediate management and clinical outcomes. Therefore, we compared outcomes in concurrent ACS patients between MEG and NA. Consecutive patients with ACS were identified at 2 locations in an international health system. Extent of epicardial coronary disease was determined using Synergy between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score by trained investigators at both locations and compared using appropriate testing. In addition, in-hospital outcomes, including death, stroke and major bleeding were compared between the two groups. Between January and December 2017, 158 patients in MEG and 381 in NA were admitted with ACS. Patients in MEG were younger (57.3±11.5 vs. 65.0±12.1 years; P<0.001) than those in NA, more likely to have diabetes (51.9% vs. 28.9%; P<0.001). MEG patients had more complex CAD (SYNTAX score: 23.5±12.3 vs. 13.2±8.6; P<0.001) and were more likely to receive surgical or hybrid revascularization [odds ratio (OR) 2.1, 95% confidence interval (CI): 1.4-3.1] but less likely to receive percutaneous coronary interventions (OR 0.3, 95% CI: 0.2-0.5). These findings suggest that patients in the MEG present at the time of their first clinical event with more severe CAD, potentially driven by a higher prevalence and poorer control of diabetes. Further studies are needed to explore genetic, environmental, and metabolic factors contributing to rapid CAD progression in MEG populations.