Primary coronary intervention versus thrombolytic therapy in myocardial infarction patients in the Middle East
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Background Little is known about predictors and outcome differences of primary percutaneous coronary intervention (PPCI) and thrombolytic therapy (TT) in ST-segment elevation myocardial infarction (STEMI) patients in the Middle East. Objective To compare predictors as well as in-hospital outcomes of PPCI and TT in STEMI patients in six Middle Eastern countries. Setting Sixty-five hospitals (covering at least 85 % of the population) in Oman, United Arab Emirates, Qatar, Bahrain, Kuwait and Yemen. Methods This was a prospective, multinational, multicentre, observational survey of consecutive acute coronary syndrome patients who were admitted to 65 hospitals during May 8, 2006 to June 6, 2006 and from January 29, 2007 to June 29, 2007, as part of Gulf RACE (Registry of Acute Coronary Events). Analyses were performed using univariate and multivariate statistical techniques. Main outcome measures Predictors as well as in-hospital outcomes of PPCI and TT in STEMI patients. Results Out of 2,155 STEMI patients admitted to hospitals within 12 h of symptoms onset, 92 % received reperfusion (8 % PPCI and 84 % TT). TT use included reteplase (43 %), tenecteplase (30 %), streptokinase (25 %), and alteplase (2 %). Median age of the study cohort was 50 (44–58) years with majority being males (90 %). There were no significant differences in median onset time to presentation between the TT and PPCI groups (130 vs. 120 min; P = 0.422). Median door-to-needle time and door-to-balloon time were 45 min (29–75) and 75 min (58–120), respectively. Predictors of PPCI included prior PCI, hospitals with catheterization laboratory facilities as well as those involved with academia. Multivariate logistic regression model demonstrated that patients that had PPCI were less likely to have recurrent ischemic attacks than those that had TT (odds ratio, 0.18; 95 % CI, 0.06–0.56; P = 0.003). Conclusions The main reperfusion strategy for STEMI patients in the Arab Middle East region is thrombolytic therapy. Predictors of primary percutaneous coronary intervention included prior percutaneous coronary intervention, hospitals with catheterization laboratory facilities as well as those involved with academia. Primary percutaneous coronary intervention resulted in significant reductions in recurrent ischemic events when compared to thrombolytic therapy.
KeywordsArab Countries Ischemic attack Myocardial infarction Primary angioplasty Thrombolysis
The authors would like to thank the patients, physicians, nurses, and support staff participating in the Gulf RACE registry for their invaluable cooperation.
We disclose the receipt of a grant for this Gulf RACE project from Gulf Heart Association with finances supported by Sanofi Aventis and Qatar Telecommunications Company.
Conflicts of interest
The authors declare no conflicts of interest with respect to the authorship and/or publication of this article.
- 1.Media centre, World Health Organization. Cardiovascular diseases (CVDs). [Internet] 2011 [cited 2011 Mar 2]. Available from: http://www.who.int/mediacentre/factsheets/fs317/en/index.html/.
- 3.Kushner FG, Hand M, Smith SC Jr, King SB III, Anderson JL, Antman EM, et al. 2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2009;54(23):2205–41.Google Scholar
- 6.The Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes (GUSTOIIb) Angioplasty Substudy Investigators. A clinical trial comparing primary coronary angioplasty with tissue plasminogen activator for acute myocardial infarction. N Engl J Med. 1997;336(23):1621–28.Google Scholar
- 10.Tiefenbrunn AJ, Chandra NC, French WJ, Gore JM, Rogers WJ. Clinical experience with primary percutaneous transluminal coronary angioplasty compared with alteplase (recombinant tissue-type plasminogen activator) in patients with acute myocardial infarction: a report from the Second National Registry of Myocardial Infarction (NRMI-2). J Am Coll Cardiol. 1998;31(6):1240–5.PubMedCrossRefGoogle Scholar
- 11.Danchin N, Vaur L, Genes N, Etienne S, Angioi M, Ferrieres J, et al. Treatment of acute myocardial infarction by primary coronary angioplasty or intravenous thrombolysis in the “real world”: one-year results from a nationwide French survey. Circulation. 1999;99(20):2639–44.PubMedCrossRefGoogle Scholar
- 13.Cannon CP, Battler A, Brindis RG, Cox JL, Ellis SG, Every NR, et al. American College of Cardiology key data elements and definitions for measuring the clinical management and outcomes of patients with acute coronary syndromes. A report of the American College of Cardiology Task Force on Clinical Data Standards (Acute Coronary Syndromes Writing Committee). J Am Coll Cardiol. 2001;38(7):2114–30.PubMedCrossRefGoogle Scholar
- 16.NCDR-ACTION registry-GWTG Results. [Internet] 2010 [cited 2011 Mar 4]. Available from: http://www.cardiosource.org/…/NCDR/…/ACTIONGWTG%20ResultsQ309_Q210.ashx/.
- 19.Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction; A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of patients with acute myocardial infarction). J Am Coll Cardiol. 2004;44(3):E1–211.PubMedCrossRefGoogle Scholar