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Acute myocardial infarction: clinical characteristics, management and outcome in a university medical centre in a developing Middle Eastern country.
Can J Cardiol. 2004 Jun; 20(8):789-93.CJ

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.

OBJECTIVES

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+Show Affiliations

Division of Cardiology, American University of Beirut, Lebanon. hd01@aub.edu.lbNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

15229760

Citation

Dakik, Habib A., et al. "Acute Myocardial Infarction: Clinical Characteristics, Management and Outcome in a University Medical Centre in a Developing Middle Eastern Country." The Canadian Journal of Cardiology, vol. 20, no. 8, 2004, pp. 789-93.
Dakik HA, Koubeissi Z, Kleiman NS, et al. Acute myocardial infarction: clinical characteristics, management and outcome in a university medical centre in a developing Middle Eastern country. Can J Cardiol. 2004;20(8):789-93.
Dakik, H. A., Koubeissi, Z., Kleiman, N. S., Nasrallah, A., Sawaya, J., Gharzuddine, W., Tamim, H., Shaar, K., & Alam, S. (2004). Acute myocardial infarction: clinical characteristics, management and outcome in a university medical centre in a developing Middle Eastern country. The Canadian Journal of Cardiology, 20(8), 789-93.
Dakik HA, et al. Acute Myocardial Infarction: Clinical Characteristics, Management and Outcome in a University Medical Centre in a Developing Middle Eastern Country. Can J Cardiol. 2004;20(8):789-93. PubMed PMID: 15229760.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Acute myocardial infarction: clinical characteristics, management and outcome in a university medical centre in a developing Middle Eastern country. AU - Dakik,Habib A, AU - Koubeissi,Zolficar, AU - Kleiman,Neal S, AU - Nasrallah,Antoine, AU - Sawaya,Jaber, AU - Gharzuddine,Walid, AU - Tamim,Hala, AU - Shaar,Khuzama, AU - Alam,Samir, PY - 2004/7/2/pubmed PY - 2004/8/4/medline PY - 2004/7/2/entrez SP - 789 EP - 93 JF - The Canadian journal of cardiology JO - Can J Cardiol VL - 20 IS - 8 N2 - 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. OBJECTIVES: 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. SN - 0828-282X UR - https://www.unboundmedicine.com/medline/citation/15229760/Acute_myocardial_infarction:_clinical_characteristics_management_and_outcome_in_a_university_medical_centre_in_a_developing_Middle_Eastern_country_ L2 - https://medlineplus.gov/heartattack.html DB - PRIME DP - Unbound Medicine ER -