Background Prior acute coronary syndrome (ACS) registries in Saudi Arabia might not have accurately described the true demographics and cardiac care of patients with ACS. We aimed to evaluate the clinical characteristics, management, and outcomes of a representative sample of patients with acute myocardial infarction (AMI) in Saudi Arabia. Methods We conducted a 1-month snap-shot, prospective, multi-center registry study in 50 hospitals from various health care sectors in Saudi Arabia. We followed patients for 1 month and 1 year after hospital discharge. Patients with AMI included those with or without ST-segment elevation (STEMI or NSTEMI, respectively). This program survey will be repeated every 5 years. Results Between May 2015 and January 2017, we enrolled 2233 patients with ACS (mean age was 56 [standard deviation = 13] years; 55.6% were Saudi citizens, 85.7% were men, and 65.9% had STEMI). Coronary artery disease risk factors were high; 52.7% had diabetes mellitus and 51.2% had hypertension. Emergency Medical Services (EMS) was utilized in only 5.2% of cases. Revascularization for patients with STEMI included thrombolytic therapy (29%), primary percutaneous coronary intervention (PCI); (42.5%), neither (29%), or a pharmaco-invasive approach (3%). Non-Saudis with STEMI were less likely to undergo primary PCI compared to Saudis (35.8% vs. 48.7%; respectively, p <0.001), and women were less likely than men to achieve a door-to-balloon time of <90 min (42% vs. 65%; respectively, p = 0.003). Around half of the patients with NSTEMI did not undergo a coronary angiogram. All-cause mortality rates were 4%, 5.8%, and 8.1%, in-hospital, at 1 month, and at 1 year, respectively. These rates were significantly higher in women than in men. Conclusions There is an urgent need for primary prevention programs, improving the EMS infrastructure and utilization, and establishing organized ACS network programs. AMI care needs further improvement, particularly for women and non-Saudis.

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Background and objective Not all patients with ST-elevation myocardial infarction (STEMI) in Saudi Arabia are managed with a primary percutaneous coronary intervention (PPCI). We analyzed the management strategies for STEMI patients in the Saudi Acute Myocardial Infarction Registry (STARS). The strategies include PPCI, revascularization with thrombolytic therapy, and conservative management. This study involved a substudy of the STARS. Methods STEMI patients were categorized into three groups. Group 1 was managed with PPCI, group 2 with revascularization with thrombolytic therapy, and group 3 with conservative approaches. The data were collected at presentation, at one month, and at one year after discharge. Results The sample consisted of 1,471 patients. The mean age of the participants was 54 ±12 years; 51% were Saudi citizens, and the majority (89%) were male. Their background revealed a high coronary risk profile, with 48% diagnosed with diabetes mellitus (DM) and 44% with hypertension (HTN); 54% were active or ex-smokers, 30% had a high lipid profile, and 74% were overweight. PPCI was performed in 42%, and 29% were managed with revascularization using thrombolytic therapy. A conservative approach was followed in 29% of the patients. Patients who had a stroke were treated conservatively due to the risk of bleeding. The patients in group 1 were mostly hypertensive with recurrent angina and a history of prior revascularization, with PPCI or coronary artery bypass grafting (CABG). The crude all-cause mortality at one year was 11%; it was 7% at one month for group 1, 8% for group 2, and 9% for group 3, which was not statistically significant. Conclusions Controlling the risk factors and improving access to PPCI in hospitals are fundamental in the management of STEMI patients. PPCI is still underused. Guideline-directed medical therapy (GDMT) is a reasonable approach if PPCI is not available.

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We describe a case of hybrid total thoracic aortic repair and valve-in-valve transcatheter aortic valve replacement in a high-risk patient with complicated chronic type A dissection and severe prosthetic aortic stenosis. The patient underwent a three-stage-procedure including aortic arch debranching, thoracic endovascular aortic repair of the ascending aorta, aortic arch and descending thoracic aorta, and direct aortic valve-in-valve replacement using transcatheter heart valve. The details of the procedures are described with a discussion of the challenges and the decision-making process.

Background: Peripheral Arterial Disease (PAD) is a marker of systemic atherosclerosis with an elevated risk of cardiovascular mortality and morbidity. This study was undertaken to identify the prevalence of PAD in patients presenting with acute coronary syndrome and do not have previous history of coronary artery disease in order to identify the missed opportunity in treating these patients and potentially avoiding such cardiovascular events.