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Al Saleh A, Jamee A, Sulaiman K, Sobhy M, Gamra H, Alkindi F, Benkhedda S, Al-Motarreb A, Amin MI, Almahmeed W, Hammoudeh A, Skouri H, Farhan HA, Al Jarallah M, Fellat N, Panduranga P, Alnajm BK, Abdelhamid M, Refaat R, Amor H, Messaous S, Ahmed HS, Chibane A, AbdulMalek A, Alsagheer NK, Dada S, Mokhtar Z, Ali M, Ullah A, AlBackr H, Alhabib KF. Clinical features, socioeconomic status, management, short and long-term outcomes of patients with acute myocardial infarction: Phase I results of PEACE MENA registry. PLoS One 2024; 19:e0296056. [PMID: 38206951 PMCID: PMC10783754 DOI: 10.1371/journal.pone.0296056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 12/06/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND The Program for the Evaluation and Management of Cardiac Events in the Middle East and North Africa (PEACE MENA) is a prospective registry program in Arabian countries that involves in patients with acute myocardial infarction (AMI) or acute heart failure (AHF). METHODS This prospective, multi-center, multi-country study is the first report of the baseline characteristics and outcomes of inpatients with AMI who were enrolled during the first 14-month recruitment phase. We report the clinical characteristics, socioeconomic, educational levels, and management, in-hospital, one month and one-year outcomes. RESULTS Between April 2019 and June 2020, 1377 patients with AMI were enrolled (79.1% males) from 16 Arabian countries. The mean age (± SD) was 58 ± 12 years. Almost half of the population had a net income < $500/month, and 40% had limited education. Nearly half of the cohort had a history of diabetes mellitus, hypertension, or hypercholesterolemia; 53% had STEMI, and almost half (49.7%) underwent a primary percutaneous intervention (PCI) (lowest 4.5% and highest 100%). Thrombolytics were used by 36.2%. (Lowest 6.45% and highest (90.9%). No reperfusion occurred in 13.8% of patients (lowest was 0% and highest 72.7%).Primary PCI was performed less frequently in the lower income group vs. high income group (26.3% vs. 54.7%; P<0.001). Recurrent ischemia occurred more frequently in the low-income group (10.9% vs. 7%; P = 0.018). Re-admission occurred in 9% at 1 month and 30% at 1 year, whereas 1-month mortality was 0.7% and 1-year mortality 4.7%. CONCLUSION In the MENA region, patients with AMI present at a young age and have a high burden of cardiac risk factors. Most of the patients in the registry have a low income and low educational status. There is heterogeneity among key performance indicators of AMI management among various Arabian countries.
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Affiliation(s)
- Ayman Al Saleh
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Amal Jamee
- Nassar Medical Complex Hospital, Ministry of Health, Khan Younes, Gaza Strip, Palestine
- Al-Quds Hospital, Gaza, Palestine
| | | | - Mohamed Sobhy
- International Cardiac Center (ICC), Alexandria, Egypt
| | - Habib Gamra
- Research Laboratory LR, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | - Fahad Alkindi
- Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Salim Benkhedda
- Cardiology Department, Mustapha Hospital, COCRG Laboratory University Benyoucef Benkhedda, Algiers, Algeria
| | | | | | - Wael Almahmeed
- Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, United Arab Emirate
| | | | - Hadi Skouri
- Cardiology Division, Internal Medicine Department at American University of Beirut Medical Center, Beirut, Lebanon
| | - Hasan A. Farhan
- Iraqi Board for Medical Specializations, Scientific Council of Cardiology. Baghdad Heart Center, Medical City, Baghdad, Iraq
| | | | | | | | | | - Magdy Abdelhamid
- Faculty of Medicine, Kasr Al Ainy Hospital, Cairo University, Giza Governorate, Egypt
| | - Rafik Refaat
- International Cardiac Center (ICC), Alexandria, Egypt
| | - Hassen Amor
- Taher Sfar University Hospital, Mahdia, Tunisia
| | - Salma Messaous
- Research Laboratory LR, Fattouma Bourguiba University Hospital, University of Monastir, Monastir, Tunisia
| | | | - Ahcene Chibane
- Internal Medicine and Cardiology Department, CHU Douéra, Algiers, University Saad Dahlab, Blida, Algeria
| | - Azzouz AbdulMalek
- Cardiology Department, Mustapha Hospital, COCRG Laboratory University Benyoucef Benkhedda, Algiers, Algeria
| | | | - Sobhi Dada
- Hammoud University Medical Center, Saida, Lebanon
| | - Zaki Mokhtar
- King Saud Hospital, Unizah, Qaseem, Saudi Arabia
| | | | - Anhar Ullah
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud Medical City, King Saud University, Riyadh, Saudi Arabia
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Hanan AlBackr
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Khalid F. Alhabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud Medical City, King Saud University, Riyadh, Saudi Arabia
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Desai AM, Desai D, Gan A, Mehta D, Ding K, Gan F, Riangwiwat T, Sethi PS, Mukherjee A, Pai RG, Prasitlumkum N. Stroke risk in radial versus femoral approach in coronary intervention: an updated systematic review and meta-analysis. J Cardiovasc Med (Hagerstown) 2023; 24:642-650. [PMID: 37409665 DOI: 10.2459/jcm.0000000000001485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
AIM Peri-cardiac catheterization (CC) stroke is associated with increased morbidity and mortality. Little is known about any potential difference in stroke risk between transradial (TR) and transfemoral (TF) approaches. We explored this question through a systematic review and meta-analysis. METHODS MEDLINE, EMBASE, and PubMed were searched from 1980 to June 2022. Randomized trials and observational studies comparing radial versus femoral access CC or intervention that reported stroke events were included. A random-effects model was used for analysis. RESULTS The total population in our 41 pooled studies comprised 1 112 136 patients - average age 65 years, women averaging 27% in TR and 31% in TF approaches. Primary analysis of 18 randomized-controlled trials (RCTs) that included a total of 45 844 patients showed that there was no statistical significance in stroke outcomes between the TR approach and the TF approach [odds ratio (OR) 0.71, 95% confidence interval (CI) 0.48-1.06, P -value = 0.013, I2 = 47.7%]. Furthermore, meta-regression analysis of RCTs including procedural duration between those two access sites showed no significance in stroke outcomes (OR 1.08, 95% CI 0.86-1.34, P -value = 0.921, I2 = 0.0%). CONCLUSIONS There was no significant difference in stroke outcomes between the TR approach and the TF approach.
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Affiliation(s)
- Aditya M Desai
- Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside
| | - Darshi Desai
- Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside
| | - Arnold Gan
- Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside
| | - Devanshi Mehta
- Osteopathic Medicine, Western University of Health Sciences, Pomona
| | - Kimberly Ding
- Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside
| | - Frances Gan
- Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside
| | - Tanawan Riangwiwat
- Division of Cardiology, University of California, Riverside School of Medicine, Riverside, California, USA
| | - Prabhdeep S Sethi
- Division of Cardiology, University of California, Riverside School of Medicine, Riverside, California, USA
| | - Ashis Mukherjee
- Division of Cardiology, University of California, Riverside School of Medicine, Riverside, California, USA
| | - Ramdas G Pai
- Division of Cardiology, University of California, Riverside School of Medicine, Riverside, California, USA
| | - Narut Prasitlumkum
- Division of Cardiology, University of California, Riverside School of Medicine, Riverside, California, USA
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Tužil J, Matějka J, Mamas MA, Doležal T. Short-term risk of periprocedural stroke relative to radial vs. femoral access: systematic review, meta-analysis, study sequential analysis and meta-regression of 2,188,047 real-world cardiac catheterizations. Expert Rev Cardiovasc Ther 2023; 21:293-304. [PMID: 36877129 DOI: 10.1080/14779072.2023.2187378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
OBJECTIVES To verify whether transradial (TRA) compared to transfemoral (TFA) cardiac catheterization reduces the risk of periprocedural stroke (PS). METHODS We reviewed (CRD42021277918) published real-world cohorts reporting the incidence of PS within 3 days following diagnostic or interventional catheterization. Meta-analyses and meta-regressions of odds ratios (OR) performed using the DerSimonian and Laird method were checked for publication bias (Egger test) and adjusted for false-positive results (study sequential analysis SSA). RESULTS The pooled incidence of PS from 2,188,047 catheterizations (14 cohorts), was 193 (105 to 355) per 100,000. Meta-analyses of adjusted estimates (OR = 0.66 (0.49 to 0.89); p = 0.007; I2 = 90%), unadjusted estimates (OR = 0.63 (0.51 to 0.77; I2 = 74%; p = 0.000)), and a sub-group of prospective cohorts (OR = 0.67 (0.48 to 0.94; p = 0.022; I2 = 16%)) had a lower risk of PS in TRA (without indication of publication bias). SSA confirmed the pooled sample size was sufficient to support these conclusions. Meta-regression decreased the unexplained heterogeneity but did not identify any independent predictor of PS nor any effect modifier. CONCLUSION Periprocedural stroke remains a rare and hard-to-predict adverse event associated with cardiac catheterization. TRA is associated with a 20% to 30% lower risk of PS in real-world/common practice settings. Future studies are unlikely to change our conclusion.
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Affiliation(s)
- Jan Tužil
- Value Outcomes s.r.o., Prague, Czech Republic.,Biomedical informatics, First Medical Faculty, Charles University, Prague, Czech Republic
| | - Jan Matějka
- Department of Cardiology, Hospital of Pardubice, Pardubice, Czech Republic.,Faculty of Health Studies, University of Pardubice, Pardubice, Czech Republic.,Academic Department of Internal Medicine, Charles University Faculty of Medicine, Hradec Králové, Czech Republic
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, University of Keele, StokeonTrent, UK
| | - Tomáš Doležal
- Value Outcomes s.r.o., Prague, Czech Republic.,Pharmacology, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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Mori H, Sakurai K, Ikari Y, Fukui K, Maeda A, Akashi Y, Ako J, Ebina T, Tamura K, Namiki A, Michishita I, Kimura K, Suzuki H. Radial versus femoral access in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction: A propensity-matched analysis from real-world data of the K-ACTIVE registry. J Cardiol 2023; 81:189-195. [PMID: 36163313 DOI: 10.1016/j.jjcc.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/16/2022] [Accepted: 08/24/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND The access site for primary percutaneous coronary intervention (PCI) for patients with ST-elevation myocardial infarction (STEMI) recently shifted from femoral to radial. However, few real-world data on Japanese patients exist. METHODS To elucidate the clinical selection and impact of the access site in STEMI patients, we analyzed a Japanese observational prospective multicenter registry of acute myocardial infarction (K-ACTIVE: Kanagawa ACuTe cardIoVascular rEgistry) in 2015 to 2021. Data were analyzed in the entire population and a propensity score-matched population adjusted for confounding factors. Major adverse cardiac event (MACE) was defined as cardiovascular death, non-fatal myocardial infarction, and non-fatal stroke. Bleeding Academic Research Consortium (BARC) type 3 or 5 was used to assess bleeding events. MACE plus BARC type 3 or 5 bleeding were considered composite events. Clinical outcomes were followed for 30 days. RESULTS The 6802 STEMI patients included 4786 patients with radial access (70.3 %) and 2016 with femoral access (29.7 %). Femoral access tended to be selected for more severe conditions than radial access. The median door-to-device time in the radial access group was significantly shorter than the femoral access group in the entire population (75 min versus 79 min, p < 0.01). After propensity score matching (each group, n = 1208), the incidence of MACE tended to be lower in the radial access group [risk ratio (RR) 0.83, 95 % confidence interval (CI) 0.63-1.09, p = 0.17]. The incidence of BARC 3 or 5 bleeding was significantly less in the radial access group (RR 0.47, 95%CI 0.23-0.97, p = 0.04). The incidence of composite events was significantly less in the radial access group (RR 0.74, 95%CI 0.57-0.96, p = 0.02). CONCLUSION In STEMI patients undergoing primary PCI, in comparison to femoral access, radial access reduced composite events in the entire population and the matched population, through a reduction in MACE and BARC 3 or 5 bleeding.
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Affiliation(s)
- Hiroyoshi Mori
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan.
| | - Kaoru Sakurai
- Department of Cardiology, Shinyurigaoka General Hospital, Kawasaki, Japan
| | - Yuji Ikari
- Department of Cardiology, Tokai University School of Medicine, Isehara, Japan
| | - Kazuki Fukui
- Department of Cardiovascular Medicine, Kanagawa Cardiovascular and Respiratory Center, Yokohama, Japan
| | - Atsuo Maeda
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
| | - Yoshihiro Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Toshiaki Ebina
- Department of Laboratory Medicine and Clinical Investigation, Yokohama City University Medical Center, Yokohama, Japan
| | - Kouichi Tamura
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Atsuo Namiki
- Department of Cardiology, Kanto Rosai Hospital, Kawasaki, Japan
| | - Ichiro Michishita
- Division of Cardiology, Yokohama Sakae Kyosai Hospital, Yokohama, Japan
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroshi Suzuki
- Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
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