The first survey of the Saudi Acute Myocardial Infarction Registry Program: Main results and long-term outcomes (STARS-1 Program)

Abstract

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.

Demographic, Behavioral, and Cardiovascular Disease Risk Factors in the Saudi Population: Results from the Prospective Urban Rural Epidemiology study (PURE-Saudi)

“…These ndings are in keeping with a decade of several previous population cross-sectional surveys (Additional Table 4 [9,10,28,29,41]. As a result of such a high prevalence of CVD risk factors, patients in Saudi Arabia present almost a decade younger than average for developed countries with acute coronary syndromes and acute heart failure and thus are at high risk for cardiovascular complications and mortality [42][43][44].…”

Correction

“…The prevalence of CAD risk factors among Saudi patients with established CAD is alarming; however, many of these are modifiable risk factors [9][10][11]. In Saudi Arabia, despite the widespread availability of hospitals with a catheterization laboratory, there are fewer patients treated with a primary percutaneous intervention [12]. The baseline knowledge about CVD among the general population has a significant public impact in developing targeted educational programs [13].…”

Acute myocardial infarction and acute heart failure in the Middle East and North Africa: Study design and pilot phase study results from the PEACE MENA registry

“…These syndromes can occur concomitantly, but more frequently, they occur independently. In the last decade, several separate AMI and AHF registries were initiated in some countries of the MENA region [9][10][11][12][13][14][15]. However, to date, there is no single registry that includes all or most countries in the region.…”