Ahmed Hersi

Absence of obesity paradox in Saudi patients admitted with acute coronary syndromes: insights from SPACE registry.

BACKGROUND AND OBJECTIVES To describe the distribution of body mass index (BMI) and its relationship with clinical features, management, and in-hospital outcomes of patients admitted with acute coronary syndromes (ACS). DESIGN AND SETTINGS The Saudi Project for Assessment of Coronary Events is a prospective registry. ACS patients admitted to 17 hospitals from December 2005–2007 were included in this study. METHODS BMI was available for 3469 patients (68.6%) admitted with ACS and categorized into 4 groups: normal weight, overweight, obese, and morbidly obese. RESULTS Of patients admitted with ACS, 72% were either overweight or obese. A high prevalence of diabetes (57%), hypertension (56.6%), dyslipidemia (42%), and smoking (32.4%) was reported. Increasing BMI was significantly associated with diabetes, hypertension, and hyperlipidemia. Overweight and obese patients were significantly younger than the normal-weight group (P=.006). However, normal-weight patients were more likely to be smokers and had 3-vessel coronary artery disease, worse left ventricular dysfunction, and ST elevation myocardial infarction. Glycoprotein IIb-IIIa antagonists were used significantly more in overweight, obese, and morbidly obese ACS patients than in normal-weight patients (P≤.001). Coronary angiography and percutaneous intervention were reported more in overweight and obese patients than in normal-weight patients (P≤.001). In-hospital outcomes were not significantly different among the BMI categories. CONCLUSION High BMI is prevalent among Saudi patients with ACS. BMI was not an independent factor for in-hospital outcomes. In contrast with previous reports, high BMI was not associated with improved outcomes, indicating the absence of obesity paradox observed in other studies.

Quality of care in primary percutaneous coronary intervention for acute ST-segment -elevation myocardial infarction: Gulf RACE 2 experience.

BACKGROUND AND OBJECTIVES Primary percutaneous coronary intervention (pPCI) has been recognized as an effective management strategy for acute ST-segment–elevation myocardial infarction (STEMI). However, there is no first-hand information regarding the quality of pPCI procedures in the Arabian Gulf countries. This study aims to explore the quality of pPCI practice. DESIGN AND SETTINGS The Gulf Race II was designed as a prospective, multinational, multicentre registry of acute coronary events, focusing on the epidemiology, management practices, and outcomes of patients with acute coronary syndrome. The study recruited consecutive patients aged 18 years and above from 65 hospitals in 6 adjacent Middle Eastern countries (Bahrain, Saudi Arabia, Qatar, Oman, United Arab Emirates, and Yemen). PATIENTS AND METHODS We used data from the Gulf Registry of Acute Coronary Events (Gulf RACE 2). We analyzed data on patients who received pPCI to assess the guidelines-supported performance measure of door-to-balloon (D2B) ≤ 90 minutes and its impact on morbidity and mortality. RESULTS Of 3432 patients with STEMI, slightly more than half (53%, n=1832) were admitted to a hospital with a cardiac catheterization laboratory (Cath-Lab). Of these, only 1006 patients (55%) received reperfusion therapy, and pPCI was used in a small predominantly male subgroup (11% of the STEMI cohort admitted to hospitals with Cath-Lab, n=198). The median D2B time in the pPCI cohort was 85 minutes, and a D2B of ≤90 minutes was achieved in only 55%. Patients with timely pPCI (D2B ≤ 90 minutes) were less likely to have cardiogenic shock and require intra-aortic balloon pump. In-hospital, 1-month and 1-year mortality were not statistically in favor of timely pPCI. CONCLUSION Primary PCI was underused in the Gulf region with low rate of acute reperfusion and no timely pPCI and thus no mortality benefit.