Background:
Developing countries have been under-represented in multinational cardiovascular registries despite playing an important role in global cardiovascular burden. The Arab Middle East is a unique region of the developing world where little is known about the characteristics, clinical practices, and hospital outcomes of patients hospitalized with an ACS. The objective of this study was to compare ACS patients hospitalized in the Arab Middle East to patients enrolled in a multinational ACS registry.
Methods:
The study sample consisted of patients (pts) recruited in 2007 with a confirmed diagnosis of ACS, including 4,445 from the Global Registry of Acute Coronary Events (GRACE) and 6,706 from the Gulf Registry of Acute Coronary Events (Gulf RACE).
Results:
The average age in Gulf RACE was nearly a decade younger than GRACE (56 vs 66 years). Patients in Gulf RACE were significantly more likely to be male (5,071(76%) vs 3,072(69%)), smoke (2,452(37%) vs 1,217(28%)), be diabetic (2,745(41%) vs 1,181(27%)) and have a STEMI (2,619(39%) vs 1,504(34%)), while less likely to be hypertensive (3,364(55%) vs 2,929(66%)) compared to pts in GRACE. Patients in Gulf RACE had a significantly higher odds of receiving aspirin (6,563(98%) vs 4,181(94%)) and statins (6,079(91%) vs 3,574(81%)) and significantly lower likelihood of being treated with ACE inhibitors or ARBs (4,618(69%) vs 3,574 (81%)), β-blockers (4,361(65%) vs (3,858 (87%)) and clopidogrel (3,605(54%) vs 3,274(73%)) during hospitalization. The reperfusion strategy of choice among eligible STEMI patients was thrombolysis in Gulf RACE (1,415(84%) vs 297(24%)), while in GRACE it was PCI (805(66%) vs 139(8%)). While overall unadjusted in-hospital mortality rates were not significantly different between Gulf RACE and GRACE (247(3.7%) vs 167(3.8%)), age stratified rates were higher for Gulf RACE across all strata. After adjustment for additional potential confounders, there were no significant differences in hospital mortality of pts enrolled in the two registries. All P<0.01
Conclusions:
Despite differences in demographics, clinical characteristics, and treatment strategies, short-term mortality rates are comparable between ACS pts enrolled in registries from different geographic settings.
Acute coronary syndrome patients with ST-segment depression have substantial mortality rates but undergo less aggressive management strategies: Insights from the global registry of acute coronary events (GRACE)
