title: Baseline characteristics, management practices, and long-term outcomes of Middle Eastern patients in the Second Gulf Registry of Acute Coronary Events (Gulf RACE-2).
abstract: OBJECTIVE
  Limited data are available on patients with acute coronary syndromes (ACS) and their long-term outcomes in the Arabian Gulf countries. We evaluated the clinical features, management, in-hospital, and long-term outcomes of in such a population.
  
  
  METHODS
  A 9-month prospective, multicenter study conducted in 65 hospitals from 6 countries that also included 30 day and 1-year mortality follow-up.
  
  
  METHODS
  ACS patients included those with ST-elevation myocardial infarction (STEMI) and non-ST-elevation acute coronary syndrome (NSTEACS), including non-STEMI and unstable angina. The registry collected the data prospectively.
  
  
  RESULTS
  Between October 2008 and June 2009, 7930 patients were enrolled. The mean age (standard deviation), 56 (17) years; 78.8% men; 71.2% Gulf citizens; 50.1% with central obesity; and 45.6% with STEMI. A history of diabetes mellitus was present in 39.5%, hypertension in 47.2%, and hyperlipidemia in 32.7%, and 35.7% were current smokers. The median time from symptom onset to hospital arrival for STEMI patients was 178 minutes (interquartile range, 210 minutes); 22.3% had primary percutaneous coronary intervention (PCI) and 65.7% thrombolytic therapy, with 34% receiving therapy within 30 minutes of arrival. Evidence-based medication rates upon hospital discharge were 68% to 95%. The in-hospital PCI was done in 21% and the coronary artery bypass graft surgery in 2.9%. The in-hospital mortality was 4.6%, at 30 days the mortality was 7.2% , and at 1 year after hospital discharge the mortality was 9.4% ; 1-year mortality was higher in STEMI (11.5%) than in NSTEACS patients (7.7%; P<.001).
  
  
  CONCLUSIONS
  Compared to developed countries, ACS patients in Arabian Gulf countries present at a relatively young age and have higher rates of metabolic syndrome features. STEMI patients present late, and their acute management is poor. In-hospital evidence-based medication rates are high, but coronary revascularization procedures are low. Long-term mortality rates increased severalfold compared with in-hospital mortality.
authors.affiliation: King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia. khalidalhabib13@hotmail.com
authors.forename: Khalid F
authors.initials: KF
authors.lastname: Alhabib
authors.forename: Kadhim
authors.initials: K
authors.lastname: Sulaiman
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al-Motarreb
authors.forename: Wael
authors.initials: W
authors.lastname: Almahmeed
authors.forename: Nidal
authors.initials: N
authors.lastname: Asaad
authors.forename: Haitham
authors.initials: H
authors.lastname: Amin
authors.forename: Ahmad
authors.initials: A
authors.lastname: Hersi
authors.forename: Shukri
authors.initials: S
authors.lastname: Al-Saif
authors.forename: Khalid
authors.initials: K
authors.lastname: AlNemer
authors.forename: Jawad
authors.initials: J
authors.lastname: Al-Lawati
authors.forename: Norah Q
authors.initials: NQ
authors.lastname: Al-Sagheer
authors.forename: Nizar
authors.initials: N
authors.lastname: AlBustani
authors.forename: Jassim
authors.initials: J
authors.lastname: Al Suwaidi
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology* / Q000628:therapy; D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000453:epidemiology* / Q000628:therapy; D017130:Angioplasty / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D003906:Developing Countries / Q000706:statistics & numerical data*; D004562:Electrocardiography / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000628:therapy; D011446:Prospective Studies; D012307:Risk Factors; D015607:Stents / Q000706:statistics & numerical data; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data; D016896:Treatment Outcome