Prevalence and prognosis of congestive heart failure in Saudi patients admitted with acute coronary syndrome (from SPACE registry).
OBJECTIVE
The aim of this study was to assess the prevalence, clinical features, and in-hospital outcomes of heart failure in patients with acute coronary syndrome (ACS).


METHODS
The Saudi Project for Assessment of Coronary Events recruited patients admitted with ACS from 17 hospitals in Saudi Arabia from 2005 to 2007. The outcomes of ACS patients with congestive heart failure (CHF) compared with those without CHF were analyzed.


RESULTS
A total of 4523 patients with ACS were identified, of whom 905 (20%) had CHF. Compared with no CHF, patients with CHF were older (62±13.1 vs. 57±12.9 years; P=0.001), less likely to be men (70 vs. 79%; P=0.001), likely to present with non-ST-segment elevation myocardial infarction (48 vs. 36%; P=0.001), likely to have diabetes (71 vs. 54%; P=0.001), hypertension (64 vs. 54%; P=0.001) and previous history of coronary artery disease (53 vs. 43%; P=0.001), and likely to have significant left ventricular systolic dysfunction (left ventricular ejection fraction <35%) (56 vs. 30%; P=0.001). Patients with CHF were less likely to receive in-hospital β-blockers (74 vs. 86%; P=0.001) and a percutaneous coronary intervention (19 vs. 50%; P=0.001). Adjusted in-hospital mortality and cardiogenic shock were higher in the CHF group (odds ratio 4.43, 95% confidence interval 2.52-7.78; and odds ratio 3.51, 95% confidence interval 2.23-5.52), respectively.


CONCLUSIONS
ACS patients with CHF in the Saudi Project for Assessment of Coronary Events were older, more likely to have more cardiac risk factors, and less likely to be treated with optimum medical treatment on admission. These findings were associated with higher incidence of their in-hospital adverse outcomes. More aggressive treatment is warranted to improve prognosis.
aKing Fahad Cardiac Center, College of Medicine, King Saud University bSecurity Forces Hospital cDepartment of Medicine, Prince Salman Heart Center, King Fahad Medical City, Riyadh dSaud Al-Babtain Cardiac Center, Dammam eKing Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
Hanan B
HB
Albackr
Khalid F
KF
Alhabib
Anhar
A
Ullah
Hussam
H
Alfaleh
Ahmad
A
Hersi
Fayez
F
Alshaer
Khalid
K
Alnemer
Shukri
S
Al Saif
Amir
A
Taraben
Tarek
T
Kashour
D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D000368:Aged; D016009:Chi-Square Distribution; D015897:Comorbidity; D005260:Female; D054625:Healthcare Disparities; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010343:Patient Admission; D062645:Percutaneous Coronary Intervention; D015995:Prevalence; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012529:Saudi Arabia / Q000453:epidemiology; D012770:Shock, Cardiogenic / Q000453:epidemiology; D013318:Stroke Volume; D016277:Ventricular Function, Left
D000319:Adrenergic beta-Antagonists