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Presentation, management, and outcomes of STEMI in Egypt: results from the European Society of Cardiology Registry on ST elevation myocardial infarction.
Egypt Heart J. 2020 Jul 01; 72(1):35.EH

Abstract

BACKGROUND

Apart from few small single-center studies, there are limited data about STEMI patients in Egypt. Nineteen Egyptian centers (with and without PCI facilities) participated in this registry with 1356 patients who were compared to 7420 patients from other ESC countries. The aims of this study were to describe the characteristics of patients with STEMI, to assess STEMI management patterns particularly the current use of reperfusion therapies, to evaluate the organization of STEMI networks across Egypt, to evaluate in-hospital patient outcome, and to compare Egyptian patients with other ESC countries.

RESULTS

Compared to other ESC countries, Egyptian patients were younger (mean age 55.4 ± 11.3 vs. 62.9 ± 12.4; p < 0.001 and 4.36% vs. 19.41%% were ≥ 75 years old; p < 0.001) with fewer females (18.44% vs. 25.63%; p < 0.001). Egypt had longer median time between symptoms onset and first medical contact: 120.0 (60.0; 240.0) vs.100.0 (50.0; 240.0) p < 0.001. Self-presentation rather than EMS presentation was the mode of admission in 86.06% in Egypt vs. 25.83% in EU countries (p < 0.001). On qualifying ECG, anterior STEMI was in 57.08% in Egypt vs. 45.98% in other countries (p < 0.001). Initial reperfusion therapy was 49.12%, 43.07%, and 7.26% for primary PCI, thrombolytic therapy and no reperfusion in Egypt vs. 85.42%, 7.26%, and 7.82% for EU countries, respectively. In-hospital mortality was 4.65% in Egypt vs. 3.50% in other countries p 0.040 and was 18.87% in no reperfusion vs. 2.10% in primary PCI vs. 4.97% in thrombolysis (p < 0.001) among Egyptians. Patients were discharged on aspirin in 98.61%, clopidogrel in 91.07%, ticagrelor in 7.31%, DAPT in 97.69%, beta blockers in 82.83%, ACE inhibitors in 84.76%, MRAs in 10.01%, and statins in 99.77%.

CONCLUSION

Compared to other ESC countries, Egyptian STEMI patients were younger, more frequently current smokers and diabetics, and had longer time between symptoms onset and first medical contact with more self-presentation rather than EMS presentation. Thrombolytic therapy is still a common reperfusion therapy in Egypt while primary PCI was offered to half of the patients. In-hospital mortality was significantly higher in Egypt and was highest among no reperfusion patients and lowest among PPCI patients.

Authors+Show Affiliations

Cardiology Department, Ain Shams University Hospitals, Ain Shams University, Cairo, Egypt. samehshaheen@gmail.com.Cardiology Department; Mansoura University Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt.Cardiology Department, Bab Elsheria and Alhosien University Hospitals, Al-Azhar Faculty of Medicine, Cairo, Egypt.Cardiology Depatrtment, National Heart Institute, Giza, Egypt.Cardiology Department, Banha University Hospital, Banha Faculty of Medicine, Banha, Egypt.Cardiology Department, Assiut University Hospitals, Assiut University, Assiut, Egypt.Cardiology Department, Fayoum General Hospital, Fayoum, Egypt.Cardiology Department, National Heart Institute, Giza, Egypt.Cardiology Department, Tanta University Hospital, Tanta University, Tanta, Egypt.Cardiology Department, Bani Sweif University Hospital, Bani Sweif University, Bani Sweif, Egypt.Cardiology Department, Fayoum University Hospital, Fayoum University, Fayoum, Egypt.Cardiology Department, Helwan University Hospital, Helwan University, Badr City, Egypt.Cardiology Department, Nasr City Insurance Hospital, Cairo, Egypt.Cardiology Department, Ain Shams University Hospitals, Ain Shams University, Cairo, Egypt.Cardiology Department, Cairo University Hospitals, Kasr Alainy Faculty of Medicine, Cairo, Egypt.Cardiology Department; Mansoura University Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt.Cardiology Department; Mansoura University Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32607863

Citation

Shaheen, Sameh, et al. "Presentation, Management, and Outcomes of STEMI in Egypt: Results From the European Society of Cardiology Registry On ST Elevation Myocardial Infarction." The Egyptian Heart Journal : (EHJ) : Official Bulletin of the Egyptian Society of Cardiology, vol. 72, no. 1, 2020, p. 35.
Shaheen S, Wafa A, Mokarab M, et al. Presentation, management, and outcomes of STEMI in Egypt: results from the European Society of Cardiology Registry on ST elevation myocardial infarction. Egypt Heart J. 2020;72(1):35.
Shaheen, S., Wafa, A., Mokarab, M., Zareef, B., Bendary, A., Abdelhameed, T., Rashwan, A., Seleem, M., Elmasry, M., Abdelhady, Y., Abdelrazik, G., Ibrahim, A., Ghareeb, M., Aly, K., Saraya, M., Wadie, M., & Youssef, M. (2020). Presentation, management, and outcomes of STEMI in Egypt: results from the European Society of Cardiology Registry on ST elevation myocardial infarction. The Egyptian Heart Journal : (EHJ) : Official Bulletin of the Egyptian Society of Cardiology, 72(1), 35. https://doi.org/10.1186/s43044-020-00069-x
Shaheen S, et al. Presentation, Management, and Outcomes of STEMI in Egypt: Results From the European Society of Cardiology Registry On ST Elevation Myocardial Infarction. Egypt Heart J. 2020 Jul 1;72(1):35. PubMed PMID: 32607863.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Presentation, management, and outcomes of STEMI in Egypt: results from the European Society of Cardiology Registry on ST elevation myocardial infarction. AU - Shaheen,Sameh, AU - Wafa,Ahmad, AU - Mokarab,Mostafa, AU - Zareef,Basem, AU - Bendary,Ahmed, AU - Abdelhameed,Tarek, AU - Rashwan,Ahmad, AU - Seleem,Mohamad, AU - Elmasry,Magdy, AU - Abdelhady,Yaser, AU - Abdelrazik,Gomaa, AU - Ibrahim,Amr, AU - Ghareeb,Mohamad, AU - Aly,Khalid, AU - Saraya,Mahmoud, AU - Wadie,Moheb, AU - Youssef,Mahmoud, Y1 - 2020/07/01/ PY - 2020/04/08/received PY - 2020/06/10/accepted PY - 2020/7/2/entrez PY - 2020/7/2/pubmed PY - 2020/7/2/medline KW - Egypt KW - Networks KW - Primary PCI KW - Registry KW - Reperfusion KW - STEMI KW - Thrombolytic SP - 35 EP - 35 JF - The Egyptian heart journal : (EHJ) : official bulletin of the Egyptian Society of Cardiology JO - Egypt Heart J VL - 72 IS - 1 N2 - BACKGROUND: Apart from few small single-center studies, there are limited data about STEMI patients in Egypt. Nineteen Egyptian centers (with and without PCI facilities) participated in this registry with 1356 patients who were compared to 7420 patients from other ESC countries. The aims of this study were to describe the characteristics of patients with STEMI, to assess STEMI management patterns particularly the current use of reperfusion therapies, to evaluate the organization of STEMI networks across Egypt, to evaluate in-hospital patient outcome, and to compare Egyptian patients with other ESC countries. RESULTS: Compared to other ESC countries, Egyptian patients were younger (mean age 55.4 ± 11.3 vs. 62.9 ± 12.4; p < 0.001 and 4.36% vs. 19.41%% were ≥ 75 years old; p < 0.001) with fewer females (18.44% vs. 25.63%; p < 0.001). Egypt had longer median time between symptoms onset and first medical contact: 120.0 (60.0; 240.0) vs.100.0 (50.0; 240.0) p < 0.001. Self-presentation rather than EMS presentation was the mode of admission in 86.06% in Egypt vs. 25.83% in EU countries (p < 0.001). On qualifying ECG, anterior STEMI was in 57.08% in Egypt vs. 45.98% in other countries (p < 0.001). Initial reperfusion therapy was 49.12%, 43.07%, and 7.26% for primary PCI, thrombolytic therapy and no reperfusion in Egypt vs. 85.42%, 7.26%, and 7.82% for EU countries, respectively. In-hospital mortality was 4.65% in Egypt vs. 3.50% in other countries p 0.040 and was 18.87% in no reperfusion vs. 2.10% in primary PCI vs. 4.97% in thrombolysis (p < 0.001) among Egyptians. Patients were discharged on aspirin in 98.61%, clopidogrel in 91.07%, ticagrelor in 7.31%, DAPT in 97.69%, beta blockers in 82.83%, ACE inhibitors in 84.76%, MRAs in 10.01%, and statins in 99.77%. CONCLUSION: Compared to other ESC countries, Egyptian STEMI patients were younger, more frequently current smokers and diabetics, and had longer time between symptoms onset and first medical contact with more self-presentation rather than EMS presentation. Thrombolytic therapy is still a common reperfusion therapy in Egypt while primary PCI was offered to half of the patients. In-hospital mortality was significantly higher in Egypt and was highest among no reperfusion patients and lowest among PPCI patients. SN - 2090-911X UR - https://www.unboundmedicine.com/medline/citation/32607863/Presentation,_management,_and_outcomes_of_STEMI_in_Egypt:_results_from_the_European_Society_of_Cardiology_Registry_on_ST_elevation_myocardial_infarction L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/32607863/ DB - PRIME DP - Unbound Medicine ER -
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