Comparison of Characteristics, Management Practices, and Outcomes of Patients Between the Global Registry and the Gulf Registry of Acute Coronary Events

doi:10.1016/j.amjcard.2011.06.040

The American Journal of Cardiology

Volume 108, Issue 9, 1 November 2011, Pages 1252-1258

https://doi.org/10.1016/j.amjcard.2011.06.040 Get rights and content

The Arab Middle East is a unique region of the developing world where little is known about the outcomes of patients hospitalized with an acute coronary syndrome (ACS), despite playing an important role in the global burden of cardiovascular disease. The primary objectives of this observational study were to compare patients with ACS hospitalized in the Arab Middle East to patients enrolled in a multinational non-Arabian ACS registry. The study cohort consisted of patients hospitalized in 2007 with an ACS including 4,445 from the Global Registry of Acute Coronary Events (GRACE) and 6,706 from the Gulf Registry of Acute Coronary Events (Gulf RACE). Average age of patients in Gulf RACE was nearly a decade younger than that in GRACE (56 vs 66 years). Patients in Gulf RACE were more likely to be men, diabetic, and smoke and less likely to be hypertensive compared to patients in GRACE. Patients in Gulf RACE had higher odds of receiving aspirin and a lower likelihood of receiving angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β blockers, and clopidogrel during their index hospitalization. Although most eligible patients with ST-elevation myocardial infarction in Gulf RACE received thrombolytics, most of their counterparts in GRACE underwent a primary percutaneous coronary intervention. Multivariable adjusted in-hospital case–fatality rates were not significantly different between patients in Gulf RACE and those in GRACE. In conclusion, despite differences in patient characteristics and treatment practices, short-term mortality rates were comparable in patients with ACS enrolled in these 2 registries. Future studies should explore the effects of these differences on long-term prognosis and other pertinent patient outcomes.

Section snippets

Methods

Full details of the Global Registry of Acute Coronary Events (GRACE) and Gulf Registry of Acute Coronary Events (Gulf RACE) projects have been previously published.1, 2, 3, 4

Gulf RACE is a prospective registry of all patients hospitalized with an ACS in 65 centers in 6 Arab Middle Eastern countries (Kuwait, Oman, United Arab Emirates, Yemen, Qatar, and Bahrain). Patients were enrolled in this observational study from January through June 2007. All hospitals that care for patients with ACS in

Results

In total 11,151 patients (4,445 from GRACE and 6,706 from Gulf RACE) with a confirmed diagnosis of ACS admitted in 2007 constituted our study population. Of patients in Gulf RACE 39% had an STEMI; of patients enrolled in GRACE 34% developed STEMI.

Patients in Gulf RACE were on average nearly a decade younger than patients enrolled in GRACE. The proportion of patients <55 years old in Gulf RACE was approximately 2 times that in GRACE, whereas the proportion of patients ≥75 years old in Gulf RACE

Discussion

The present study is the first to compare the characteristics, management practices, and hospital outcomes of patients with ACS in the Arab Middle East to a large multinational and predominantly “Western” population hospitalized with ACS. Our study shows that patients with ACS in the Arab Middle East were younger, more likely to have diabetes, and currently smoke cigarettes. They were more likely to present to participating hospitals after prolonged delay after the onset of acute coronary

Acknowledgment

We greatly appreciate the contributions and support of Gordon FitzGerald, PhD.

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Cited by (31)

Baseline characteristics, management practices, and long-term outcomes among patients with first presentation acute myocardial infarction in the Second Gulf Registry of Acute Coronary Events (Gulf RACE-II)
2018, Journal of the Saudi Heart Association
Citation Excerpt :
The Second Gulf Registry of Acute Coronary Events (Gulf RACE-II) represents distinct racial and sociodemographic characteristics of ACS patients in Gulf country regions. A previous study compared Gulf RACE-II registry with the well-known Global Registry of Acute Coronary Events (GRACE), and the authors found a significant difference in age, with almost a decade difference between the two cohorts [11]. In the National Registry of Myocardial Infarction, a large and prospective US registry, the authors correlated atherosclerotic risk factors and short-term mortality after first AMI, and the results showed higher mortality among patients with diabetes mellitus [12].
Limited data are available highlighting the different clinical aspects of acute coronary syndrome (ACS) patients, especially in Gulf countries. In this study, we aimed to compare patients who presented with acute myocardial infarction (AMI) as the first presentation of patients who have a history of ACS in terms of initial presentation, medical history, laboratory findings, and overall mortality.
We used the Second Gulf Registry of Acute Coronary Events (Gulf RACE-II), which is a multinational observational study of 7930 ACS patients.
Among all patients, 4723 (59.6%) patients presented with AMI. First presentation AMI patients were older (mean age, 55 years vs. 53 years; p < 0.001) and had lower risk factors than patients with a history of ACS. Higher laboratory readings of cardiac markers and all aspects of mortality were significantly higher among patients with first presentation AMI. After adjustments for baseline variables, congestive heart failure [odds ratio (OR) = 1.08; 95% confidence interval (CI), 0.73–1.57], reinfarction (OR = 1.16; 95% CI, 0.58–2.30), cardiogenic shock (OR = 1.51; 95% CI, 0.74–3.08), stroke (OR = 2.30; 95% CI, 0.29–17.99), and overall mortality (OR = 1.16; 95% CI = 0.74–1.83) were independent predictive factors for first presentation AMI.
First presentation AMI patients tend to be older and to have lower rates of risk factors. Adverse clinical outcomes such as congestive heart failure, reinfarction, cardiogenic shock, and stroke were higher among patients with first presentation AMI compared to patients with a history of ACS.
Acute coronary syndrome among patients with chest pain: Prevalence, incidence and risk factors
2016, International Journal of Cardiology
Background: Urbanization and adoption of new diet and lifestyles had increased the cardiovascular risk factor (CVRF) rate and therefore, acute coronary syndrome (ACS) in developing countries such as Tunisia. We aimed at determining ACS prevalence among a sample of Tunisian patients with chest pain, at establishing the standardized incidence rate (SIR) of ACS, and at quantifying the relationship between ASC and CVRF in this population. Methods: We studied 3158 patients admitted to a chest pain unit for non-traumatic chest pain collected in Emergency Data from January 2012 to December 2014. For all patients, the data were collected using a standardized form. We performed univariate rather than multivariate logistic regression analyses to identify age and gender-related CVRF in ACS. Linear interpolation was used for curve estimation. Results: 707 (22.3%) chest pain patients were classified as ACS. The age-SIR per 10^− 5 person year (PY) was 85.7; it was 112.6 in men and 45.3 in women. Eighty one percent of patient with ACS cumulated 2 CVRF and more. The highest odds ratio were 2.00 (95% CI 1.64–2.44) for diabetes and 1.81 (95% CI 1.50–2.18) for active smoking. ACS in elderly patients was significantly associated with active smoking (OR: 2.36), diabetes (OR: 1.72) and personal ACS history (OR: 1.71). We found a significant and very high linear relation between the number of CVRF and ACS odds ratio (R² = 0.958). Conclusion: Our results showed that the incidence of ACS in a Tunisian population is not very different from what is observed in developed countries; with a close relation with CVRF especially diabetes and smoking.
Opportunistic Screening for CVD Risk Factors: The Dubai Shopping for Cardiovascular Risk Study (DISCOVERY)
2015, Global Heart
Comprehensive cardiovascular disease risk factor (CVDRF) screening programs are limited in the developing world. Simplifying screening can increase its utility.
The present study aims to estimate the burden of CVDRF in volunteers and the yield of newly discovered CVDRF comparing different sites and nationalities using this screening method.
Voluntary point-of-care CVDRF screening was conducted in 4 shopping malls, 9 health care facilities, and 3 labor camps in 5 cities in the United Arab Emirates. Follow-up for newly diagnosed diabetes mellitus, hypertension, and dyslipidemia was made 1 month after screening to inquire about physician consultation, confirmation of diagnosis, and lifestyle changes.
A total of 4,128 subjects were screened (43% at malls, 36% at health care facilities, and 22% at labor camps). Subjects were relatively young (38 ± 11 years), predominantly male (75%), and of diverse nationalities (United Arab Emirates: 7%, other Arabs: 10%, South Asians: 74%, other Asians: 5%, and other nationalities: 5%). CVDRF were frequent (diabetes mellitus: 32%, hypertension: 31%, dyslipidemia: 69%, current smokers: 21%, obesity: 20%, and central obesity: 24%). Most subjects (85%) had ≥1 CVDRF, and many (17%) had ≥3 CVDRF. A new diagnosis of diabetes mellitus, hypertension, or dyslipidemia was uncovered in 61.5%, with the highest yield (74.0%) in labor camps. At follow-up of those with new CVDRF, positive lifestyle changes were reported in 60%, but only 33% had consulted a doctor; of these, diagnosis was confirmed in 63% for diabetes mellitus, 93% for hypertension, and 87% for dyslipidemia.
In this relatively young and ethnically diverse cohort, CVDRF burden and yield of screening was high. Screening in these settings is pertinent and can be simplified.
Depression among Cardiovascular Patients Living in a Middle Eastern Country - Preliminary findings from a cross-sectional survey
2014, International Journal of Cardiology
Characteristics, treatment and one-year outcomes of patients with acute coronary syndrome in a tertiary hospital in India
2014, Indian Heart Journal
Citation Excerpt :
This is similar to some previous reports14 but contrasts other reports that suggested women with ACS are less aggressively managed.15 The 1-year mortality rate observed in the current report is lower than the values in most multicentre Registries.6,10–12 It is however comparable to the findings in some single centre- based studies.13,16
Coronary artery disease (CAD) is a major cause of death in India. Data on outcome of CAD is scarce in the Indian population. This study determined the characteristics, treatment and one-year outcomes of acute coronary syndrome (ACS) in an Indian Cardiac Centre.
We carried out a cross sectional retrospective analysis of 1468 ACS patients hospitalized between January 2008 and December 2010 and followed up for 1 year in the Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai. Mortality at 1 year, its determinants and 1 year major adverse cardiac events (MACE) were determined.
The patients were aged 62.2 ± 11.2 years; males (75.2%) and had ST segment elevation myocardial infarction (STEMI) (33.9%), non ST segment elevation myocardial infarction (44.2%) and unstable angina (21.9%). Key pharmacotherapy included aspirin (98.2%), clopidogrel (95.1%), statins (95.6%), angiotensin converting enzyme inhibitor/angiotensin receptor blocker (50.6%) and beta blocker (83.1%). Angiography rate was 80.6%. In the STEMI group, 53.3% had primary angioplasty, 20.3% were thrombolysed and 16.1% received sole medical therapy. Overall coronary artery bypass graft rate was 12.4%. At one year, all-cause mortality and composite MACE were 2.5% and 9.7%, respectively. MACE included death (2.5%), reinfarction (4.0%), resuscitated cardiac arrest (1.8%), stroke (1.1%) and bleeding (0.4%). Main factors associated with mortality were combined left ventricular systolic and diastolic dysfunction (OR = 20.0, 95% CI = 6.63–69.4) and positive troponin I (OR = 12.56, 95% CI = 1.78–25.23). Troponin I independently predicted mortality.
ACS population was older than previously described in India. Evidence-based pharmacotherapy and interventions, and outcomes were comparable to the developed nations.
Depression in cardiovascular patients in the Middle Eastern populations
2013, International Journal of Cardiology

View all citing articles on Scopus

: This work was supported by an unrestricted educational grant from Sanofi Aventis, Bridgewater, New Jersey.

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Coronary artery diseaseComparison of Characteristics, Management Practices, and Outcomes of Patients Between the Global Registry and the Gulf Registry of Acute Coronary Events

Section snippets

Methods

Results

Discussion

Acknowledgment

Am J Cardiol

J Am Coll Cardiol

Am J Cardiol

Am Heart J

Am Heart J

Am J Cardiol

Rationale and design of the GRACE (Global Registry of Acute Coronary Events) Project: a multinational registry of patients hospitalized with acute coronary syndromes

Am Heart J

Management and outcomes of Middle Eastern patients admitted with acute coronary syndromes in the Gulf Registry of Acute Coronary Events (Gulf RACE)

Acta Cardiol

Strategies of patient care in acute coronary syndromes: rationale for the Global Registry of Acute Coronary Events (GRACE) registry

Am J Cardiol

Clinical presentation and outcomes of acute coronary syndromes in the Gulf Registry of Acute Coronary Events (Gulf RACE)

Saudi Med J

Heart failure in patients hospitalized with acute coronary syndromes: observations from the Gulf Registry of Acute Coronary Events (Gulf RACE)

Eur J Heart Fail

Kuwait Acute Coronary Syndromes Registry: baseline characteristics, management practices and in-hospital outcomes of patients hospitalized with acute coronary syndromes in Kuwait

Med Princ Pract

Coronary artery disease
Comparison of Characteristics, Management Practices, and Outcomes of Patients Between the Global Registry and the Gulf Registry of Acute Coronary Events