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Clinical Presentation, Quality of Care, Risk Factors and Outcomes in Women with Acute ST-Elevation Myocardial Infarction (STEMI): An Observational Report from Six Middle Eastern Countries

[ Vol. 17 , Issue. 4 ]

Author(s):

Abdulla Shehab*, Khalid F. AlHabib, Akshaya S. Bhagavathula, Ahmad Hersi, Hussam Alfaleh, Mostafa Q. Alshamiri, Anhar Ullah, Khadim Sulaiman, Wael Almahmeed, Jassim Al Suwaidi, Alwai A. Alsheikh-Ali, Haitham Amin, Mohammed Al Jarallah and Amar M. Salam   Pages 388 - 395 ( 8 )

Abstract:


Background: Most of the available literature on ST-Elevated myocardial infarction (STEMI) in women was conducted in the developed world and data from Middle-East countries was limited.

Aims: To examine the clinical presentation, patient management, quality of care, risk factors and inhospital outcomes of women with acute STEMI compared with men using data from a large STEMI registry from the Middle East.

Methods: Data were derived from the third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps), a prospective, multinational study of adults with acute STEMI from 36 hospitals in 6 Middle-Eastern countries. The study included 2928 patients; 296 women (10.1%) and 2632 men (89.9%). Clinical presentations, management and in-hospital outcomes were compared between the 2 groups.

Results: Women were 10 years older and more likely to have diabetes mellitus, hypertension, and hyperlipidemia compared with men who were more likely to be smokers (all p<0.001). Women had longer median symptom-onset to emergency department (ED) arrival times (230 vs. 170 min, p<0.001) and ED to diagnostic ECG (8 vs. 6 min., p<0.001). When primary percutaneous coronary intervention (PPCI) was performed, women had longer door-to-balloon time (DBT) (86 vs. 73 min., p=0.009). When thrombolytic therapy was not administered, women were less likely to receive PPCI (69.7 vs. 76.7%, p=0.036). The mean duration of hospital stay was longer in women (6.03 ± 22.51 vs. 3.41 ± 19.45 days, p=0.032) and the crude in-hospital mortality rate was higher in women (10.4 vs. 5.2%, p<0.001). However, after adjustments, multivariate analysis revealed a statistically non-significant trend of higher inhospital mortality among women than men (6.4 vs. 4.6%), (p=0.145).

Conclusion: Our study demonstrates that women in our region have almost double the mortality from STEMI compared with men. Although this can partially be explained by older age and higher risk profiles in women, however, correction of identified gaps in quality of care should be attempted to reduce the high morbidity and mortality of STEMI in our women.

Keywords:

ST-elevated myocardial infraction, acute coronary syndrome, percutaneous coronary intervention, quality of care, mortality, Middle-East.

Affiliation:

Internal Medicine Department, College of Medicine and Health Sciences (CMHS), UAE University, Al Ain, Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Department of Clinical Pharmacy, University of Gondar, College of Medicine and Health Sciences, Gondar, Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Department of Cardiology, Royal Hospital, Muscat, Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, Department of Cardiology, Hamad Medical Corporation (HMC), Doha, College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, Mohammed Bin Khalifa Cardiac Center, Manama, Mohammed Bin Khalifa Cardiac Center, Manama, Adult Cardiology, Hamad Medical Corporation, Doha

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