Mohammad Ibrahim Kurdi

The Saudi Project for Assessment of Coronary Events (SPACE) registry: Design and results of a phase I pilot study

OBJECTIVE The delay between the availability of clinical evidence and its application to the care of patients with acute coronary syndrome (ACS) in the Kingdom of Saudi Arabia remains undefined. The Saudi Project for Assessment of Coronary Events (SPACE) registry provides a comprehensive view of the current diagnostic and treatment strategies for patients with ACS; thus, the registry may be used to identify opportunities to improve the care of these patients. METHODS Eight hospitals in different regions of Saudi Arabia were involved in the pilot phase of the registry, from December 2005 to July 2006. The study patients included individuals with ST segment elevation myocardial infarction (STEMI), non-STEMI and unstable angina. RESULTS A total of 435 patients (77% men and 80% Saudis) with a mean age of 57.1 years were enrolled. Medical history included previously diagnosed ischemic heart disease (32%), percutaneous coronary intervention (12%), diabetes mellitus (53%), hypertension (48%), current smoking (39%), hyperlipidemia (31%) and family history of premature coronary artery disease (11%). The median door-to-needle time for fibrinolytic therapy received by patients with STEMIs was 90 min. Inhospital medications included acetylsalicylic acid (98%), clopidogrel (73%), angiotensin- converting enzyme inhibitors (74%), beta-blockers (73%), statins (88%), unfractionated heparin (80%), low-molecular weight heparin (22%) and glycoprotein IIb/IIIa inhibitors (9%). The inhospital mortality rate was 5%. CONCLUSION The first nationwide registry of patients with ACS in the Kingdom of Saudi Arabia is presented. In contrast to registries from developed countries, our cohort is characterized by a younger age at presentation and a much higher prevalence of diabetes mellitus. Most patients with STEMIs did not receive fibrinolytic therapy within the time recommended in the American College of Cardiology/American Heart Association guidelines. The results of the present pilot study show potential targets for improvement in care.

CRP levels are higher in patients with ST elevation than non-ST elevation acute coronary syndrome.

FUNDAMENTO: Hay gran interes en el uso de proteina C-reactiva de alta sensibilidad (PCR-as) para evaluacion de riesgo. Altos niveles de PCR-as en el comienzo del sindrome coronario agudo (SCA), antes de la necrosis tisular, puede ser un marcador sustituto para comorbilidades cardiovasculares. OBJETIVO: De esa forma, nuestro objetivo fue estudiar diferentes medidas de seguimiento de niveles de PCR-as en pacientes con SCA y comparar las diferencias entre infarto de miocardio sin elevacion del segmento ST (NSTEMI) con pacientes presentando elevacion del segmento ST (STEMI). METODOS: Este es un estudio observacional. De los 89 pacientes reclutados, 60 presentaban infarto agudo de miocardio (IAM). Tres niveles seriados de PCR-us, a nivel basal en la hospitalizacion antes de 12 horas despues del inicio de los sintomas, niveles de pico 36-48 horas despues de hospitalizacion y niveles de control despues de 4 a 6 semanas fueron analizados y comparados entre pacientes con (IAMCSST) y sin supradesnivel del segmento ST (IAMSSST). RESULTADOS: Pacientes con IAMCSST tenian IMC significativamente mas alta cuando fueron comparados con pacientes IAMSSST. Los niveles de creatinoquinasa fraccion MB (CK-MB) y aspartato aminotransferasa (AST) eran significativamente mas altos en pacientes con IAMCSST cuando fueron comparados con pacientes con IAMSSST (p<0,05). Los niveles de PCR a nivel basal y en el control no difirieron de forma significativa entre los dos grupos (p= 0,2152 y p=0,4686 respectivamente). Hubo una diferencia significativa en los niveles de pico de PCR entre los dos grupos. En el grupo de pacientes con IAMCSST los niveles fueron significativamente mas altos cuando fueron comparados a los pacientes con IAMSSST (p=0,0464). CONCLUSION: Pacientes con IAMCSST presentan picos significativamente mas elevados de PCR cuando son comparados a pacientes IAMSSST. Esos datos sugieren que el proceso inflamatorio tiene un papel independiente en la patogenesis del infarto de miocardio. De esa forma, los niveles de PCR pueden ayudar en la estratificacion de riesgo despues del infarto de miocardio.BACKGROUND There is intense interest in the use of high-sensitivity C-reactive protein (hsCRP) for risk assessment. Elevated hsCRP concentrations early in acute coronary syndrome (ACS), prior to the tissue necrosis, may be a surrogate marker for cardiovascular co-morbidities. OBJECTIVE Therefore we aimed to study different follow up measurements of hsCRP levels in acute coronary syndrome patients and to compare the difference between non-ST elevation myocardial infarction (NSTEMI) and ST myocardial infarction (STEMI) patients. METHODS This is an observational study. Of the 89 patients recruited 60 patients had acute myocardial infarction (AMI). Three serial hsCRP levels at baseline on admission to hospital before 12 hours of symptom onset, peak levels at 36-48 hours and follow up levels after 4-6 weeks were analyzed and compared between non-ST elevation AMI and ST elevation AMI. RESULTS STEMI patients had significantly higher BMI compared to NSTEMI patients. Creatine kinase myocardial bound (CKMB) and Aspartate aminotransferase (AST) levels were significantly higher in STEMI patients compared to NSTEMI patients (p<0.05). CRP levels at baseline and at follow up did not significantly differ between the two groups (p = 0.2152, p = 0.4686 respectively). There was a significant difference regarding peak CRP levels between the two groups, as STEMI patients had significantly higher peak CRP levels compared to NSTEMI patients (p = 0.0464). CONCLUSION STEMI patients have significantly higher peak CRP levels compared to NSTEMI patients. These data suggest that inflammatory processes play an independent role in the pathogenesis of myocardial infarction. Thus, CRP assessment may assist in risk stratification after myocardial infarction.

Níveis de PCR são maiores em pacientes com síndrome coronariana aguda e supradesnivelamento do segmento ST do que em pacientes sem supradesnivelamento do segmento ST

FUNDAMENTO: Hay gran interes en el uso de proteina C-reactiva de alta sensibilidad (PCR-as) para evaluacion de riesgo. Altos niveles de PCR-as en el comienzo del sindrome coronario agudo (SCA), antes de la necrosis tisular, puede ser un marcador sustituto para comorbilidades cardiovasculares. OBJETIVO: De esa forma, nuestro objetivo fue estudiar diferentes medidas de seguimiento de niveles de PCR-as en pacientes con SCA y comparar las diferencias entre infarto de miocardio sin elevacion del segmento ST (NSTEMI) con pacientes presentando elevacion del segmento ST (STEMI). METODOS: Este es un estudio observacional. De los 89 pacientes reclutados, 60 presentaban infarto agudo de miocardio (IAM). Tres niveles seriados de PCR-us, a nivel basal en la hospitalizacion antes de 12 horas despues del inicio de los sintomas, niveles de pico 36-48 horas despues de hospitalizacion y niveles de control despues de 4 a 6 semanas fueron analizados y comparados entre pacientes con (IAMCSST) y sin supradesnivel del segmento ST (IAMSSST). RESULTADOS: Pacientes con IAMCSST tenian IMC significativamente mas alta cuando fueron comparados con pacientes IAMSSST. Los niveles de creatinoquinasa fraccion MB (CK-MB) y aspartato aminotransferasa (AST) eran significativamente mas altos en pacientes con IAMCSST cuando fueron comparados con pacientes con IAMSSST (p<0,05). Los niveles de PCR a nivel basal y en el control no difirieron de forma significativa entre los dos grupos (p= 0,2152 y p=0,4686 respectivamente). Hubo una diferencia significativa en los niveles de pico de PCR entre los dos grupos. En el grupo de pacientes con IAMCSST los niveles fueron significativamente mas altos cuando fueron comparados a los pacientes con IAMSSST (p=0,0464). CONCLUSION: Pacientes con IAMCSST presentan picos significativamente mas elevados de PCR cuando son comparados a pacientes IAMSSST. Esos datos sugieren que el proceso inflamatorio tiene un papel independiente en la patogenesis del infarto de miocardio. De esa forma, los niveles de PCR pueden ayudar en la estratificacion de riesgo despues del infarto de miocardio.BACKGROUND There is intense interest in the use of high-sensitivity C-reactive protein (hsCRP) for risk assessment. Elevated hsCRP concentrations early in acute coronary syndrome (ACS), prior to the tissue necrosis, may be a surrogate marker for cardiovascular co-morbidities. OBJECTIVE Therefore we aimed to study different follow up measurements of hsCRP levels in acute coronary syndrome patients and to compare the difference between non-ST elevation myocardial infarction (NSTEMI) and ST myocardial infarction (STEMI) patients. METHODS This is an observational study. Of the 89 patients recruited 60 patients had acute myocardial infarction (AMI). Three serial hsCRP levels at baseline on admission to hospital before 12 hours of symptom onset, peak levels at 36-48 hours and follow up levels after 4-6 weeks were analyzed and compared between non-ST elevation AMI and ST elevation AMI. RESULTS STEMI patients had significantly higher BMI compared to NSTEMI patients. Creatine kinase myocardial bound (CKMB) and Aspartate aminotransferase (AST) levels were significantly higher in STEMI patients compared to NSTEMI patients (p<0.05). CRP levels at baseline and at follow up did not significantly differ between the two groups (p = 0.2152, p = 0.4686 respectively). There was a significant difference regarding peak CRP levels between the two groups, as STEMI patients had significantly higher peak CRP levels compared to NSTEMI patients (p = 0.0464). CONCLUSION STEMI patients have significantly higher peak CRP levels compared to NSTEMI patients. These data suggest that inflammatory processes play an independent role in the pathogenesis of myocardial infarction. Thus, CRP assessment may assist in risk stratification after myocardial infarction.

SHA 102. Tissue plasminogen activator and plasminogen activator inhibitor-1 levels in patients with acute myocardial infarction and unstable angina

<1.8 mmol/L was achieved in 32%, in contrast to 40% at follow-up (P < 0.044). Twenty-three percent of patients at baseline had their glycated hemoglobin <0.070, improved to 33% at follow-up (P < 0.004). Prescription of beta blockers declined from 97% at enrollment to 90% at follow-up (P < 0.002). Utilization of lipid lowering agents was 98% with no change after follow up (P= 1). Conclusion: Nurse-led CVDMP in KAMC was effective in controlling cardiovascular risk factors in patients with CAD and adheres to utilization of evidence based CAD medications.

Niveles de PCR son mayores en pacientes con síndrome coronario agudo y supradesnivel del segmento ST que en pacientes sin supradesnivel del segmento ST

FUNDAMENTO: Hay gran interes en el uso de proteina C-reactiva de alta sensibilidad (PCR-as) para evaluacion de riesgo. Altos niveles de PCR-as en el comienzo del sindrome coronario agudo (SCA), antes de la necrosis tisular, puede ser un marcador sustituto para comorbilidades cardiovasculares. OBJETIVO: De esa forma, nuestro objetivo fue estudiar diferentes medidas de seguimiento de niveles de PCR-as en pacientes con SCA y comparar las diferencias entre infarto de miocardio sin elevacion del segmento ST (NSTEMI) con pacientes presentando elevacion del segmento ST (STEMI). METODOS: Este es un estudio observacional. De los 89 pacientes reclutados, 60 presentaban infarto agudo de miocardio (IAM). Tres niveles seriados de PCR-us, a nivel basal en la hospitalizacion antes de 12 horas despues del inicio de los sintomas, niveles de pico 36-48 horas despues de hospitalizacion y niveles de control despues de 4 a 6 semanas fueron analizados y comparados entre pacientes con (IAMCSST) y sin supradesnivel del segmento ST (IAMSSST). RESULTADOS: Pacientes con IAMCSST tenian IMC significativamente mas alta cuando fueron comparados con pacientes IAMSSST. Los niveles de creatinoquinasa fraccion MB (CK-MB) y aspartato aminotransferasa (AST) eran significativamente mas altos en pacientes con IAMCSST cuando fueron comparados con pacientes con IAMSSST (p<0,05). Los niveles de PCR a nivel basal y en el control no difirieron de forma significativa entre los dos grupos (p= 0,2152 y p=0,4686 respectivamente). Hubo una diferencia significativa en los niveles de pico de PCR entre los dos grupos. En el grupo de pacientes con IAMCSST los niveles fueron significativamente mas altos cuando fueron comparados a los pacientes con IAMSSST (p=0,0464). CONCLUSION: Pacientes con IAMCSST presentan picos significativamente mas elevados de PCR cuando son comparados a pacientes IAMSSST. Esos datos sugieren que el proceso inflamatorio tiene un papel independiente en la patogenesis del infarto de miocardio. De esa forma, los niveles de PCR pueden ayudar en la estratificacion de riesgo despues del infarto de miocardio.BACKGROUND There is intense interest in the use of high-sensitivity C-reactive protein (hsCRP) for risk assessment. Elevated hsCRP concentrations early in acute coronary syndrome (ACS), prior to the tissue necrosis, may be a surrogate marker for cardiovascular co-morbidities. OBJECTIVE Therefore we aimed to study different follow up measurements of hsCRP levels in acute coronary syndrome patients and to compare the difference between non-ST elevation myocardial infarction (NSTEMI) and ST myocardial infarction (STEMI) patients. METHODS This is an observational study. Of the 89 patients recruited 60 patients had acute myocardial infarction (AMI). Three serial hsCRP levels at baseline on admission to hospital before 12 hours of symptom onset, peak levels at 36-48 hours and follow up levels after 4-6 weeks were analyzed and compared between non-ST elevation AMI and ST elevation AMI. RESULTS STEMI patients had significantly higher BMI compared to NSTEMI patients. Creatine kinase myocardial bound (CKMB) and Aspartate aminotransferase (AST) levels were significantly higher in STEMI patients compared to NSTEMI patients (p<0.05). CRP levels at baseline and at follow up did not significantly differ between the two groups (p = 0.2152, p = 0.4686 respectively). There was a significant difference regarding peak CRP levels between the two groups, as STEMI patients had significantly higher peak CRP levels compared to NSTEMI patients (p = 0.0464). CONCLUSION STEMI patients have significantly higher peak CRP levels compared to NSTEMI patients. These data suggest that inflammatory processes play an independent role in the pathogenesis of myocardial infarction. Thus, CRP assessment may assist in risk stratification after myocardial infarction.