title: Acute myocardial infarction: clinical characteristics, management and outcome in a university medical centre in a developing Middle Eastern country.
abstract: BACKGROUND
  The management and outcome of acute myocardial infarction (AMI) have not been well studied in developing countries, although demographic data from the World Health Organization indicate that developing countries contribute a major share to the global burden of cardiovascular disease.
  
  
  OBJECTIVE
  To analyze the clinical characteristics, management and outcome of patients hospitalized with AMI in a university medical centre in a developing Middle Eastern country.
  
  
  METHODS
  The study population comprised all patients hospitalized with AMI at the American University of Beirut between January 1, 1997, and December 30, 1998. The medical records of the patients were reviewed to determine their clinical characteristics, the diagnostic and invasive procedures used during the hospitalization, and any in-hospital complications, including death.
  
  
  RESULTS
  The population comprised 184 patients with a mean age of 60+/-13 years. Fifty-two per cent of the infarcts were anterior and 76% developed Q waves. Fifty-one per cent of the patients received thrombolytic therapy. At discharge, 80% of the patients were given acetylsalicylic acid, 35% were given beta-blockers, 34% were given angiotensin-converting enzyme inhibitors and 30% were given statins. Seventy-two per cent of the patients underwent coronary angiography, 23% underwent percutaneous transluminal coronary angioplasty and 13% had coronary artery bypass grafting. The in-hospital mortality was 13%. The predictors of in-hospital mortality were advanced age (over 60 years), diabetes, prior AMI, Killip class greater than I and ejection fraction less that 40%. In contrast, the predictors of coronary angiography were younger age (less than 60 years), absence of diabetes or no history of AMI, Killip class I and ejection fraction greater than 40%.
  
  
  CONCLUSIONS
  Coronary angiography after AMI was performed more frequently than expected in a university medical centre in a developing country, and it seemed to be selectively used in the low- risk patients rather than the high-risk ones. Furthermore, the underuse of medical therapy with beta-blockers and statins was evident. These findings should prompt cardiac societies in these countries to initiate educational campaigns focusing on the cost-effectiveness of therapy in AMI to optimize the use of their limited resources.
authors.affiliation: Division of Cardiology, American University of Beirut, Lebanon. hd01@aub.edu.lb
authors.forename: Habib A
authors.initials: HA
authors.lastname: Dakik
authors.forename: Zolficar
authors.initials: Z
authors.lastname: Koubeissi
authors.forename: Neal S
authors.initials: NS
authors.lastname: Kleiman
authors.forename: Antoine
authors.initials: A
authors.lastname: Nasrallah
authors.forename: Jaber
authors.initials: J
authors.lastname: Sawaya
authors.forename: Walid
authors.initials: W
authors.lastname: Gharzuddine
authors.forename: Hala
authors.initials: H
authors.lastname: Tamim
authors.forename: Khuzama
authors.initials: K
authors.lastname: Shaar
authors.forename: Samir
authors.initials: S
authors.lastname: Alam
mesh_terms: D002317:Cardiovascular Agents / Q000627:therapeutic use; D015331:Cohort Studies; D017023:Coronary Angiography / Q000706:statistics & numerical data; D003906:Developing Countries; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007861:Lebanon / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011237:Predictive Value of Tests; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D010975:Platelet Aggregation Inhibitors