PLoS ONE (Jan 2019)

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

  • Khalid F Alhabib,
  • Abdulhalim J Kinsara,
  • Saleh Alghamdi,
  • Mushabab Al-Murayeh,
  • Gamal Abdin Hussein,
  • Shukri AlSaif,
  • Hassan Khalaf,
  • Hussam Alfaleh,
  • Ahmad Hersi,
  • Tarek Kashour,
  • Ayman Al-Saleh,
  • Mohammad Ali,
  • Anhar Ullah,
  • Hassan Mhish,
  • Abdulrahman Nouri Abdo,
  • Fawaz Almutairi,
  • Mohammed R Arafah,
  • Raed AlKutshan,
  • Mubarak Aldosari,
  • Basel Y AlSabatien,
  • Mohammad Alrazzaz,
  • Adel M Maria,
  • Aziza H Aref,
  • Muhammed M Selim,
  • Ayman M Morsy,
  • Fathi A AlTohari,
  • Ammar A Alrifai,
  • Awatif A Awaad,
  • Hassan El-Sayed,
  • Sherief Mansour,
  • Ashraf A Atwa,
  • Salah Abdelkader,
  • Naif Altamimi,
  • Elnatheer Saleh,
  • Wael Alhaidari,
  • El Husseini A ElShihawy,
  • Ali H Busaleh,
  • Mohammed Abdalmoutaleb,
  • Essam M Fawzy,
  • Zaki Mokhtar,
  • Adil M Saleh,
  • Mohammed A Ahmad,
  • Adel Almasswary,
  • Mohammed Alshehri,
  • Khalid M Abohatab,
  • Turki AlGarni,
  • Modaser Butt,
  • Ibrahim Altaj,
  • Farhan Abdullah,
  • Yahya Alhosni,
  • Hadia B Osman,
  • Najeebullah Bugti,
  • Atif A Aziz,
  • Abdulrahman Alarabi,
  • Ibrahim A AlHarbi

DOI
https://doi.org/10.1371/journal.pone.0216551
Journal volume & issue
Vol. 14, no. 5
p. e0216551

Abstract

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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.