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Shehab A, Bakir S, Sabbour H, Elnour AA, Mahmeed WA, Salam AM, Kholy DE. Prevalence of Cardiovascular Risk Factors and 10-Years Risk for Coronary Heart Disease in the United Arab Emirates. Curr Diabetes Rev 2023; 19:38-48. [PMID: 35593359 DOI: 10.2174/1573399818666220421113607] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/17/2021] [Accepted: 12/22/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND In the United Arab Emirates (UAE), cardiovascular diseases (CVDs) are the leading cause of mortality, and the incidence of premature coronary heart diseases (CHDs) is about 10-15 years earlier than that in people of western countries. AIM The current cross-sectional study aims to describe the prevalence of CVD risk factors and estimate the 10-years risk for CHDs in the population of Abu Dhabi, UAE. OBJECTIVE The main objective was to report the 10-years risk for CHD in a sample of the UAE population. METHODS We have analyzed the dataset from the Abu Dhabi Screening Program for Cardiovascular Risk Markers (AD-SALAMA), a population-based cross-sectional survey conducted between 2009 and 2015 (a sample of 1002, 20 to 79 years old without CVDs or diabetes). RESULTS 18.0% of our sample have had hypertension (HTN), 26.3% were current smokers, 33% have had total cholesterol ≥200 mg/dL, 55.0% have had non-high-density lipoprotein (non-HDL) levels ≥130 mg/dL, 33.1% have had low-density lipoprotein cholesterol (LDL-C) levels ≥130 mg/dL, calculated by β-quantification as 112.3 ± 47.1 mg/dL. 66.8% were overweight or obese, and 46.2% had a sedentary lifestyle. Nearly 85% of our sample has had one or more major cardiovascular risk factors. The estimated 10-year risk of cardiovascular disease according to different risk assessment tools was as follows: 7.1% according to the national cholesterol education program Framingham risk score (FRAM-ATP), 2.9% according to Pooled Cohort Risk Assessment Equation (PCRAE) , 1.4% according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III), and 1.1% according to Reynolds Risk Score. Despite the fact that our sample population have had exhibited major risk factors, the above-mentioned international scoring systems underestimate the 10-year risk of cardiovascular diseases, given the high prevalence at younger ages. CONCLUSION The proportion of modifiable risk factors has been found to be high in the UAE population, and the majority of them have had one or more risk factors with a higher 10-years risk for CHDs.
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Affiliation(s)
- Abdulla Shehab
- Department of Cardiology, Burjeel Royal Hospital, Al-Ain, UAE
| | - Sherif Bakir
- Department of Cardiology, Kids, and Adult Heart Centers Dubai and Abu Dhabi, Dhabi, UAE
| | - Hani Sabbour
- Department of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, UAE
| | - Asim A Elnour
- Program of Clinical Pharmacy, College of Pharmacy, Al Ain University, Abu Dhabi Campus, Abu Dhabi, UAE
- AAU Health and Biomedical Research Center, Al Ain University, Abu Dhabi, UAE
| | - Wael Al Mahmeed
- Department of Cardiology, Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, UAE
| | - Amar M Salam
- Department of Medicine, Weill Cornell Medical College, New York, USA
| | - Doaa El Kholy
- Department of Cardiology, Mediclinic Al Ain Hospital, Al Ain, UAE
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
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Salam AM, Kaddoura R, Salih V, Asopa S. Atrial fibrillation in Middle Eastern Arabs and South Asians: a scoping review. Rev Cardiovasc Med 2021; 22:1185-1196. [PMID: 34957762 DOI: 10.31083/j.rcm2204127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 11/06/2022] Open
Abstract
Most of the published literature on Atrial fibrillation (AF) originates from the northern hemisphere and mainly involves Caucasian patients, with limited studies in certain ethnicities and races. This scoping review was conducted to collect and summarize the pertinent evidence from the published scientific literature on AF in South Asians and Middle Eastern Arabs. MEDLINE, Embase and CENTRAL databases were included in our search. After screening 8995 records, 55 studies were selected; 42 from the Middle East and 13 from South Asia. Characteristics of the included studies were tabulated, and their data were summarized for study design, setting, enrolment period, sample size, demographics, prevalence or incidence of AF, co-morbidities, risk factors, AF types and symptoms, management, outcomes, and risk determinants. Identified literature gaps included a paucity of community or population-based studies that are representative of these two ethnicities/races. In addition, studies that addressed ethnic/racial in-equality and access to treatment were lacking. Our study underscores the urgent need to study cardiovascular disorders, particularly AF, in South Asians and Middle Eastern Arabs as well as in other less represented ethnicities and races.
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Affiliation(s)
- Amar M Salam
- College of Medicine, QU Health, Qatar University, 2713 Doha, Qatar.,Adult Cardiology, Hamad Medical Corporation, 3050 Doha, Qatar.,Department of Medicine, Weill Cornell Medical College, NY 61319, USA
| | - Rasha Kaddoura
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, 3050 Doha, Qatar
| | - Vehid Salih
- Peninsula School of Dentistry, University of Plymouth, PL4 8AA Plymouth, UK
| | - Sanjay Asopa
- South West Cardiothoracic Centre, University Hospitals Plymouth, PL6 8DH Plymouth, UK
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Abstract
Background Cardiogenic shock (CS) is an acute complex condition leading to morbidity and mortality. Vasoactive medications, such as vasopressors and inotropes are considered the cornerstone of pharmacological treatment of CS to improve end-organ perfusion by increasing cardiac output (CO) and blood pressure (BP), thus preventing multiorgan failure. Objective A critical review was conducted to analyze the currently available randomized studies of vasoactive agents in CS to determine the indications of each agent and to critically appraise the methodological quality of the studies. Methods PubMed database search was conducted to identify randomized controlled trials (RCTs) on vasoactive therapy in CS. After study selection, the internal validity of the selected studies was critically appraised using the three-item Jadad scale. Results Nine studies randomized 2388 patients with a mean age ranged between 62 and 69 years, were identified. Seven of studies investigated CS in the setting of acute myocardial infarction (AMI). The studies evaluated the comparisons of norepinephrine (NE) vs. dopamine, epinephrine vs. NE, levosimendan vs. dobutamine, enoximone or placebo, and nitric oxide synthase inhibitors (NOSi) vs. placebo. The mean Jadad score of the nine studies was 3.33, with only three studies of a score of 5. Conclusions The evidence from the studies of vasoactive agents in CS carries uncertainties. The methodological quality between the studies is variable due to the inherent difficulties to conduct a study in CS. Vasopressors and inotropes continue to have a fundamental role given the lack of pharmacological alternatives.
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Affiliation(s)
- Rasha Kaddoura
- Heart Hospital Pharmacy, Hamad Medical Corporation, Doha, Qatar
| | - Amr Elmoheen
- Emergency Department, Hamad Medical Corporation, Doha, Qatar
| | - Ehab Badawy
- Emergency Department, Hamad Medical Corporation, Doha, Qatar
| | | | - Mohamed A Seif
- Emergency Department, Hamad Medical Corporation, Doha, Qatar
| | - Khalid Bashir
- Emergency Department, Hamad Medical Corporation, Doha, Qatar
| | - Amar M Salam
- College of Medicine, QU Health, Qatar University, Doha, Qatar.,Adult Cardiology, Hamad Medical Corporation, Doha, Qatar
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4
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Salam AM, Carr AS. From "Heart and Reins" to Clinical Syndromes: Origin and Evolution of Cardio-Renal Disease. Heart Views 2021; 22:80-84. [PMID: 34276897 PMCID: PMC8254159 DOI: 10.4103/heartviews.heartviews_210_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/14/2021] [Indexed: 11/06/2022] Open
Affiliation(s)
- Amar M Salam
- Department of Cardiology, Al-Khor Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Alison S Carr
- College of Medicine, QU Health, Qatar University, Doha, Qatar
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Singh R, Varughese B, El-Menyar A, Shahbal S, Al Maslamani Y, Salam AM, Al Thani H. Opt-Out Consent at Different Levels of Attitude to Organ Donation: A Household Survey in Qatar. J Multidiscip Healthc 2021; 14:401-410. [PMID: 33633451 PMCID: PMC7901440 DOI: 10.2147/jmdh.s285011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 01/29/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Demand for an organ transplant is surpassing the number of organ donors and hence increasing waiting lists worldwide, compelling many countries to adopt an opt-out consent system for organ donation. Opt-out is used in several European countries and has increased organ registration rate. No study on this subject has been published from the gulf region to associate sociodemographic characteristics, knowledge, attitude, beliefs, and intention domains regarding an opt-out consent for organ donation. Materials and Methods A household survey was conducted between October and November 2016 using a validated questionnaire. Integer codes were assigned for qualitative data to interpret results at par with quantitative data for each domain to allow data for advanced statistical analysis. Results Of 1044 surveyed participants, 724 (69.34%) those aged 37.7±10.4 agreed to adopting an opt-out consent system of which 231 (29.4%) were Qatari citizens and 353 (48.8%) were males. Mean levels of indices such as attitude, behavioral beliefs, and intention domains to organ donation were found higher in opt out participants. After adjusting statistical significant variables, multivariate analysis showed that attitude index was associated to opt out system (OR: 16.7, 95% C.I.:10.6-26.3, p=0.001) whereas; knowledge index (OR: 0.25, 95% C.I.: 0.07-0.83, p=0.03), behavioral beliefs (OR: 0.55, 95% C.I.: 0.35-0.86, p=0.009) and intention indices (OR: 0.42, 95% C.I.: 0.20-0.87, p=0.02) were associated with opt-in system for organ donation in Qatar. Regression model was able to discriminate (AUC: 84%, 95% C.I.:81% to 87%) for opt-out consent. Future probabilities for opt-out consent were 0.80, 0.88, 0.92,0.95,0.96,0.97,0.99 and 0.993 for 0.20, 0.30, 0.40, 0.50, 0.60, 0.70, 0.80 and 0.90 attitude levels after using 200 re-samples to make traditional multivariate regression model to realistic model for the population. Conclusion The majority of the survey participants showed a good attitude but less knowledge, behavioral beliefs, and intention towards adopting an opt-out system for organ donation in Qatar.
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Affiliation(s)
- Rajvir Singh
- Cardiology Research Center, Heart Hospital, Hamad Medical Corporation (HMC), Doha, Qatar
| | | | | | - Saad Shahbal
- Cardiology Research Center, Heart Hospital, Hamad Medical Corporation (HMC), Doha, Qatar
| | | | - Amar M Salam
- Department of Cardiology & Cardiovascular Surgery, Hamad Medical Corporation, Doha, Qatar
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6
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Kaddoura R, Salam AM. Thrombosis Management and Challenges in COVID-19 Patients Presenting with Acute Coronary Syndromes. Heart Views 2020; 21:195-208. [PMID: 33688412 PMCID: PMC7898995 DOI: 10.4103/heartviews.heartviews_143_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 01/08/2023] Open
Abstract
Thrombotic complications in patients with coronavirus disease 2019 (COVID-19) infection have been increasingly recognized, particularly those affecting the cardiovascular system. Patients with COVID-19 infection can suffer from increased coagulopathy as well as myocardial injury. In this review, we discuss these complications with special focus on management challenges in patients with acute coronary disease based on the available evidence from published literature.
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Affiliation(s)
- Rasha Kaddoura
- Department of Cardiology and Cardiovascular Surgery,Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Amar M Salam
- Department of Cardiology, Al Khor Hospital, Hamad Medical Corporation, Doha, Qatar.,College of Medicine, QU Health, Qatar University, Doha, Qatar
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Salam AM, Ahmed MB, Sulaiman K, Singh R, Alhashemi M, Carr AS, Alsheikh-Ali AA, AlHabib KF, Al-Zakwani I, Panduranga P, Asaad N, Shehab A, AlMahmeed W, Al Suwaidi J. Clinical presentation and outcomes of peripartum cardiomyopathy in the Middle East: a cohort from seven Arab countries. ESC Heart Fail 2020; 7:4134-4138. [PMID: 32964700 PMCID: PMC7754996 DOI: 10.1002/ehf2.13030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/05/2020] [Accepted: 09/09/2020] [Indexed: 12/02/2022] Open
Abstract
Aims Published data on the clinical presentation of peripartum cardiomyopathy (PPCM) are very limited particularly from the Middle East. The aim of this study was to examine the clinical presentation, management, and outcomes of patients with PPCM using data from a large multicentre heart failure (HF) registry from the Middle East. Methods and results From February to November 2012, a total of 5005 consecutive patients with HF were enrolled from 47 hospitals in 7 Middle East countries. From this cohort, patients with PPCM were identified and included in this study. Clinical features, in‐hospital, and 12 months outcomes were examined. During the study period, 64 patients with PPCM were enrolled with a mean age of 32.5 ± 5.8 years. Family history was identified in 11 patients (17.2%) and hypertension in 7 patients (10.9%). The predominant presenting symptom was dyspnoea New York Heart Association class IV in 51.6%, class III in 31.3%, and class II in 17.2%. Basal lung crepitations and peripheral oedema were the predominant signs on clinical examination (98.2% and 84.4%, respectively). Most patients received evidence‐based HF therapies. Inotropic support and mechanical ventilation were required in 16% and 5% of patients, respectively. There was one in‐hospital death (1.6%), and after 1 year of follow‐up, nine patients were rehospitalized with HF (15%), and one patient died (1.6%). Conclusions A high index of suspicion of PPCM is required to make the diagnosis especially in the presence of family history of HF or cardiomyopathy. Further studies are warranted on the genetic basis of PPCM.
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Affiliation(s)
- Amar M Salam
- College of Medicine, QU Health, Qatar University, University street, Doha, 2713, Qatar.,Adult Cardiology, Hamad Medical Corporation, Hamad Medical city, Rayan Street, Doha, 3050, Qatar.,Department of Medicine, Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA
| | - Mohamed Badie Ahmed
- College of Medicine, QU Health, Qatar University, University street, Doha, 2713, Qatar
| | | | - Rajvir Singh
- Biostatistics Section, Clinical Research, Hamad General Hospital, Doha, Qatar
| | - Mohammed Alhashemi
- Adult Cardiology, Hamad Medical Corporation, Hamad Medical city, Rayan Street, Doha, 3050, Qatar
| | - Alison S Carr
- College of Medicine, QU Health, Qatar University, University street, Doha, 2713, Qatar
| | - Alawi A Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim Al-Zakwani
- College of Medicine and Health Sciences, Department of Pharmacology and Clinical Pharmacy, Sultan Qaboos University, and Gulf Health Research, Muscat, Oman
| | | | - Nidal Asaad
- Adult Cardiology, Hamad Medical Corporation, Hamad Medical city, Rayan Street, Doha, 3050, Qatar
| | - Abdulla Shehab
- College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates
| | | | - Jassim Al Suwaidi
- Adult Cardiology, Hamad Medical Corporation, Hamad Medical city, Rayan Street, Doha, 3050, Qatar.,Department of Medicine, Weill Cornell Medical College, 1300 York Ave, New York, NY, 10065, USA
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8
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Abstract
Objective Treatment of dyslipidemia lowers cardiovascular (CV) risk. Although statin use is a cornerstone therapy, many patients are not achieving their risk-specific low-density lipoprotein cholesterol (LDL-C) goals. The proprotein convertase subtilisin/kexin type 9 (PCSK9) monoclonal antibodies have been extensively studied as lipid-lowering therapy (LLT). Herein, we present an updated evidence-based review of the efficacy and safety of PCSK9 monoclonal antibodies in the treatment of familial and non-familial hypercholesterolemia. Methods PubMed database was searched to review Phase III studies on PCSK9 monoclonal antibodies. Then, the US National Institutes of Health Registry and the WHO International Clinical Trial Registry Platform were searched to identify and present the ongoing research. Results PCSK9 monoclonal antibodies were investigated for the treatment of dyslipidemia, as a single therapeutic agent or as an add-on therapy to the traditional LLT. They proved effective and safe in the treatment of familial and non-familial hypercholesterolemia, and in the prevention of adverse CV events. Conclusions The use of PCSK9 monoclonal antibodies in the treatment of dyslipidemia is currently recommended to achieve risk-specific LDL-C goal to reduce adverse CV events. Future results of the ongoing research might expand their clinical generalizability to broader patient populations.
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Affiliation(s)
- Rasha Kaddoura
- Hamad Medical Corporation, Heart Hospital Pharmacy, Doha, Ad Dawhah, Qatar
| | - Bassant Orabi
- Hamad Medical Corporation, Heart Hospital Pharmacy, Doha, Ad Dawhah, Qatar
| | - Amar M Salam
- Department of Cardiology, Hamad Medical Corporation, Al-khor Hospital, Doha, Ad Dawhah, Qatar
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Salam AM, Carr AS. Racing for COVID-19 Vaccine and Cure: Lessons and Tragedies in Human Subject Research. Heart Views 2020; 21:229-234. [PMID: 33688417 PMCID: PMC7899008 DOI: 10.4103/heartviews.heartviews_144_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 08/19/2020] [Indexed: 11/04/2022] Open
Abstract
Pressured by the enormous human and economic costs of the COVID-19 pandemic, certain countries and political figures have advocated the use of drugs and vaccines that did not go through the required regulatory stages of the development. Although the reason for bypassing these stages in a race to produce a treatment and vaccine for the COVID-19 patients could have been caused by good intentions to stop the human suffering from the pandemic, nonetheless, history has taught us that the results of this action could be catastrophic. In this article, we briefly review the lessons and tragedies in the evolution of human subject research regulations emphasizing the need for the proper evaluation of drugs and vaccines for COVID-19.
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Affiliation(s)
- Amar M. Salam
- Department of Cardiology, Al-Khor Hospital, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, QU Health, Qatar University, Doha, Qatar
- College of Medicine, Weill Cornell Medical College, New York, NY, USA
| | - Alison S. Carr
- College of Medicine, QU Health, Qatar University, Doha, Qatar
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10
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Shehab A, AlHabib KF, Bhagavathula AS, Hersi A, Alfaleh H, Alshamiri MQ, Ullah A, Sulaiman K, Almahmeed W, Al Suwaidi J, Alsheikh-Ali AA, Amin H, Al Jarallah M, Salam AM. Clinical Presentation, Quality of Care, Risk Factors and Outcomes in Women with Acute ST-Elevation Myocardial Infarction (STEMI): An Observational Report from Six Middle Eastern Countries. Curr Vasc Pharmacol 2020. [PMID: 29542414 DOI: 10.2174/1570161116666180315104820] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Most of the available literature on ST-Elevated myocardial infarction (STEMI) in women was conducted in the developed world and data from Middle-East countries was limited. AIMS To examine the clinical presentation, patient management, quality of care, risk factors and inhospital outcomes of women with acute STEMI compared with men using data from a large STEMI registry from the Middle East. METHODS Data were derived from the third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps), a prospective, multinational study of adults with acute STEMI from 36 hospitals in 6 Middle-Eastern countries. The study included 2928 patients; 296 women (10.1%) and 2632 men (89.9%). Clinical presentations, management and in-hospital outcomes were compared between the 2 groups. RESULTS Women were 10 years older and more likely to have diabetes mellitus, hypertension, and hyperlipidemia compared with men who were more likely to be smokers (all p<0.001). Women had longer median symptom-onset to emergency department (ED) arrival times (230 vs. 170 min, p<0.001) and ED to diagnostic ECG (8 vs. 6 min., p<0.001). When primary percutaneous coronary intervention (PPCI) was performed, women had longer door-to-balloon time (DBT) (86 vs. 73 min., p=0.009). When thrombolytic therapy was not administered, women were less likely to receive PPCI (69.7 vs. 76.7%, p=0.036). The mean duration of hospital stay was longer in women (6.03 ± 22.51 vs. 3.41 ± 19.45 days, p=0.032) and the crude in-hospital mortality rate was higher in women (10.4 vs. 5.2%, p<0.001). However, after adjustments, multivariate analysis revealed a statistically non-significant trend of higher inhospital mortality among women than men (6.4 vs. 4.6%), (p=0.145). CONCLUSION Our study demonstrates that women in our region have almost double the mortality from STEMI compared with men. Although this can partially be explained by older age and higher risk profiles in women, however, correction of identified gaps in quality of care should be attempted to reduce the high morbidity and mortality of STEMI in our women.
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Affiliation(s)
- Abdulla Shehab
- Internal Medicine Department, College of Medicine and Health Sciences (CMHS), UAE University, Al Ain, United Arab Emirates
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Akshaya S Bhagavathula
- Department of Clinical Pharmacy, University of Gondar, College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Ahmad Hersi
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Hussam Alfaleh
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Mostafa Q Alshamiri
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Anhar Ullah
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | | | - Wael Almahmeed
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Jassim Al Suwaidi
- Department of Cardiology, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Alwai A Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.,Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.,Tufts Clinical and Translational Science Institute, Tufts Medical Center, Boston, MA, United States
| | - Haitham Amin
- Mohammed Bin Khalifa Cardiac Center, Manama, Bahrain
| | | | - Amar M Salam
- Adult Cardiology, Hamad Medical Corporation, Doha, Qatar
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11
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Abstract
PCSK9 monoclonal antibodies are novel lipid-lowering therapy that have been extensively studied in patients with hypercholesterolemia either as monotherapy or as an add-on to other LLTs. PCSK9 monoclonal antibodies have significantly reduced the low-density lipoprotein cholesterol (LDL-C) plasma level resulting in a better LDL-C goal attainment. The commercially available PCSK9 monoclonal antibodies, alirocumab and evolocumab, have demonstrated reductions in major adverse cardiovascular events such as myocardial infarction, stroke, unstable angina, and the need for coronary revascularization but not mortality. PCSK9 monoclonal antibodies have demonstrated a favorable safety profile. The most reported side effects are mild injection site with no causal relationship proven between the inhibition of PCSK9 and neurocognitive or glycemic adverse events. In this overview, the efficacy and safety of PCSK9 monoclonal antibodies in the treatment of primary and familial hypercholesterolemia will be discussed.
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Affiliation(s)
- Rasha Kaddoura
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Bassant Orabi
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Amar M Salam
- Department of Cardiology, Al Khor Hospital, Hamad Medical Corporation, Doha, Qatar
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12
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Salam AM, Sulaiman K, Alsheikh-Ali AA, Singh R, AlHabib KF, Al-Zakwani I, Asaad N, Al-Qahtani A, Al-Jarallah M, AlMahmeed W, Bulbanat B, Ridha M, Bazargani N, Amin H, Al-Motarreb A, Panduranga P, AlFaleh H, Shehab A, Al Suwaidi J. Precipitating Factors for Hospitalization with Heart Failure: Prevalence and Clinical Impact Observations from the Gulf CARE (Gulf aCute heArt failuRe rEgistry). Med Princ Pract 2020; 29:270-278. [PMID: 31522185 PMCID: PMC7315136 DOI: 10.1159/000503334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 09/15/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Despite the expanding burden of heart failure (HF) worldwide, data on HF precipitating factors (PFs) in developing countries, particularly the Middle East, are very limited. We examined PFs in patients hospitalized with acute HF in a prospective multicenter HF registry from 7 countries in the Middle East. METHOD Data were derived from the Gulf CARE (Gulf aCute heArt failuRe rEgistry) for a prospective, multinational, multicenter study of consecutive patients hospitalized with HF in 47 hospitals in 7 Middle Eastern countries between February 2012 and November 2012. PFs were determined by the treating physician from a predefined list at the time of hospitalization. RESULTS The study included 5,005 patients hospitalized with acute HF, 2,276 of whom (45.5%) were hospitalized with acute new-onset HF (NOHF) and 2,729 of whom (54.5%) had acute decompensated chronic HF (DCHF). PFs were identified in 4,319 patients (86.3%). The most common PF in the NOHF group was acute coronary syndromes (ACS) (39.2%). In the DCHF group, it was noncompliance with medications (27.8%). Overall, noncompliance with medications was associated with a lower inhospital mortality (OR 0.47; 95% CI 0.28-0.80; p = 0.005) but a higher 1-year mortality (OR 1.43; 95% CI 1.1-1.85; p = 0.007). ACS was associated with higher inhospital mortality (OR 1.84; 95% CI 1.26-2.68; p = 0.002) and higher 1-year mortality (OR 1.62; 95% CI 1.27-2.06; p = 0.001). CONCLUSION Preventive and therapeutic interventions specifically directed at noncompliance with medications and ACS are warranted in our region.
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Affiliation(s)
- Amar M Salam
- College of Medicine, Qatar University, Doha, Qatar,
- Adult Cardiology, Hamad Medical Corporation, Doha, Qatar,
| | | | - Alawi A Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
- Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Rajvir Singh
- Biostatistics Section, Cardiovascular Research, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim Al-Zakwani
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, and Gulf Health Research, Seeb, Oman
| | - Nidal Asaad
- College of Medicine, Qatar University, Doha, Qatar
| | | | | | | | - Bassam Bulbanat
- Department of Cardiology, Sabah Al-Ahmed Cardiac Center, Kuwait, Kuwait
| | - Mustafa Ridha
- Department of Cardiology, Adan Hospital, Kuwait, Kuwait
| | - Nooshin Bazargani
- Department of Cardiology, Dubai Hospital, Dubai, United Arab Emirates
| | - Haitham Amin
- Department of Cardiology, Mohammed Bin Khalifa Cardiac Center, Manamah, Bahrain
| | - Ahmed Al-Motarreb
- Department of Cardiology, Faculty of Medicine, Sana'a University, Sana'a, Yemen
| | | | - Husam AlFaleh
- Department of Cardiology and Cardiovascular Surgery, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Abdulla Shehab
- College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates
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13
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Doi SA, Islam N, Sulaiman K, Alsheikh-Ali AA, Singh R, Al-Qahtani A, Asaad N, AlHabib KF, Al-Zakwani I, Al-Jarallah M, AlMahmeed W, Bulbanat B, Bazargani N, Amin H, Al-Motarreb A, AlFaleh H, Panduranga P, Shehab A, Al Suwaidi J, Salam AM. Demystifying Smoker's Paradox: A Propensity Score-Weighted Analysis in Patients Hospitalized With Acute Heart Failure. J Am Heart Assoc 2019; 8:e013056. [PMID: 31779564 PMCID: PMC6912958 DOI: 10.1161/jaha.119.013056] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Smoker's paradox has been observed with several vascular disorders, yet there are limited data in patients with acute heart failure (HF). We examined the effects of smoking in patients with acute HF using data from a large multicenter registry. The objective was to determine if the design and analytic approach could explain the smoker's paradox in acute HF mortality. Methods and Results The data were sourced from the acute HF registry (Gulf CARE [Gulf Acute Heart Failure Registry]), a multicenter registry that recruited patients over 10 months admitted with a diagnosis of acute HF from 47 hospitals in 7 Middle Eastern countries. The association between smoking and mortality (in hospital) was examined using covariate adjustment, making use of mortality risk factors. A parallel analysis was performed using covariate balancing through propensity scores. Of 5005 patients hospitalized with acute HF, 1103 (22%) were current smokers. The in-hospital mortality rates were significantly lower in current smoker's before (odds ratio, 0.71; 95% CI, 0.52-0.96) and more so after (odds ratio, 0.47; 95% CI, 0.31-0.70) covariate adjustment. With the propensity score-derived covariate balance, the smoking effect became much less certain (odds ratio, 0.63; 95% CI, 0.36-1.11). Conclusions The current study illustrates the fact that the smoker's paradox is likely to be a result of residual confounding as covariate adjustment may not resolve this if there are many competing prognostic confounders. In this situation, propensity score methods for covariate balancing seem preferable. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01467973.
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Affiliation(s)
- Suhail A Doi
- College of Medicine QU Health Qatar University Doha Qatar
| | - Nazmul Islam
- College of Medicine QU Health Qatar University Doha Qatar
| | | | - Alawi A Alsheikh-Ali
- Mohammed Bin Rashid University of Medicine and Health Sciences Abu Dhabi United Arab Emirates
| | | | | | | | - Khalid F AlHabib
- Department of Cardiac Sciences King Fahad Cardiac Center King Saud University Riyadh Saudi Arabia
| | - Ibrahim Al-Zakwani
- Department of Pharmacology and Clinical Pharmacy College of Medicine and Health Sciences Sultan Qaboos University Muscat Oman
| | | | - Wael AlMahmeed
- Sheikh Khalifa Medical City Abu Dhabi United Arab Emirates
| | - Bassam Bulbanat
- Department of Cardiology Sabah Al-Ahmed Cardiac Center ??? Kuwait
| | | | - Haitham Amin
- Department of Cardiology Mohammed Bin Khalifa Cardiac Center Manamah Bahrain
| | - Ahmed Al-Motarreb
- Department of Cardiology Faculty of Medicine Sana'a University Sana'a Yemen
| | - Husam AlFaleh
- Department of Cardiac Sciences King Fahad Cardiac Center King Saud University Riyadh Saudi Arabia
| | | | - Abdulla Shehab
- College of Medicine and Health Sciences UAE University ??? United Arab Emirates
| | - Jassim Al Suwaidi
- Hamad Medical Corporation Doha Qatar.,Weill Cornell Medical College Doha Qatar
| | - Amar M Salam
- College of Medicine QU Health Qatar University Doha Qatar.,Hamad Medical Corporation Doha Qatar.,Weill Cornell Medical College Doha Qatar
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14
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Salam AM. Atrial Fibrillation in Middle Eastern Arabs and South Asians: Summary of Published Articles in the Arabian Gulf. Heart Views 2019; 20:158-165. [PMID: 31803372 PMCID: PMC6881872 DOI: 10.4103/heartviews.heartviews_116_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 11/03/2019] [Indexed: 01/30/2023] Open
Abstract
Seven studies are summarized herein focusing on different aspects of Atrial fibrillation (AF) in two unique ethnicities for which there is very limited literature published before; Middle Eastern Arabs and South Asians, using data from a national registry of cardiovascular diseases in Qatar over a 20-years period (1991-2010). These studies shed light upon important aspects of AF presentations and outcomes in these two ethnicities, thereby enriching the world literature on AF. In the process, several novel observations were reported and new questions were raised that warrant further investigations.
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Affiliation(s)
- Amar M Salam
- Department of Cardiology, Al-Khor Hospital. Hamad Medical Corporation, Doha, Qatar
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15
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Affiliation(s)
- Amar M Salam
- Department of Medicine, College of Medicine, Qatar University, New York, USA.,Weill Cornell Medical College, New York, USA.,Department of Cardiology, Al-Khor Hospital, Hamad Medical Corporation, Doha, Qatar
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16
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Albackr HB, AlHabib KF, AlShamiri MQ, Ullah A, Al Subaie FA, Alghamdi AG, Alfaleh H, Kashour T, Al Suwaidi J, Alsheikh-Ali AA, Almahmeed W, Salam AM. Circadian Rhythm and ST-Segment Elevation Myocardial Infarction: Insights From the Third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps). Angiology 2018; 70:352-360. [DOI: 10.1177/0003319718797470] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Circadian rhythms have been identified in multiple physiological processes that may affect cardiovascular diseases, yet little is known about the impact of circadian rhythm on acute ST-segment elevation myocardial infarction (STEMI) onset and outcomes in the Middle East. The relationship between time of symptom onset during the 24-hour circadian cycle and prehospital delays and in-hospital death was assessed in 2909 patients with STEMI presenting in 6 Arabian Gulf countries. A sinusoidal smoothing function was used to show the average circadian trends. There was a significant association between time of symptom onset and the circadian cycle. The STEMIs were more frequent during the late morning and early afternoon hours ( P < .001). Patients with pain onset from 0.00 to 5:59 had median prehospital delays of 150 minutes versus 90 minutes from 6:00 to 11:59 and 12:00 to 17:59, respectively ( P < .001). Although there was no significant difference in mortality between the 4 groups ( P = .230), there was a significant association between time of symptom onset as sinusoidal function and in-hospital mortality ( P = .032). Patients with STEMI in the Middle East have significant circadian patterns in symptoms onset, prehospital delay, and timeliness of reperfusion. A circadian rhythm of in-hospital mortality was found over the 24-hour clock of symptom onset time.
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Affiliation(s)
- Hanan B. Albackr
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Khalid F. AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Mostafa Q. AlShamiri
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Anhar Ullah
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Fahad A. Al Subaie
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Abduljabar G. Alghamdi
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Hussam Alfaleh
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Tarek Kashour
- Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Jassim Al Suwaidi
- Department of Cardiology, Hamad Medical Corporation (HMC), Doha, Qatar
| | - Alawi A. Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Wael Almahmeed
- Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Amar M. Salam
- Department of Cardiology, Hamad Medical Corporation (HMC), Doha, Qatar
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17
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Salam AM, Sulaiman K, Alsheikh-Ali AA, Singh R, Asaad N, Al-Qahtani A, Salim I, AlHabib KF, Al-Zakwani I, Al-Jarallah M, AlMahmeed W, Bulbanat B, Ridha M, Bazargani N, Amin H, Al-Motarreb A, Al Faleh H, Albackr H, Panduranga P, Shehab A, Al Suwaidi J. Acute heart failure presentations and outcomes during the fasting month of Ramadan: an observational report from seven Middle Eastern countries. Curr Med Res Opin 2018; 34:237-245. [PMID: 28871820 DOI: 10.1080/03007995.2017.1376629] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Fasting during the month of Ramadan is practiced by over 1.5 billion Muslims worldwide. It remains unclear, however, how this change in lifestyle affects heart failure, a condition that has reached epidemic dimensions. This study examined the effects of fasting in patients with acute heart failure (AHF) using data from a large multi-center heart failure registry. METHODS AND RESULTS Data were derived from Gulf CARE (Gulf aCute heArt failuRe rEgistry), a prospective multi-center study of consecutive patients hospitalized with AHF during February-November 2012. The study included 4,157 patients, of which 306 (7.4%) were hospitalized with AHF in the fasting month of Ramadan, while 3,851 patients (92.6%) were hospitalized in other days. Clinical characteristics, precipitating factors, management, and outcome were compared among the two groups. Patients admitted during Ramadan had significantly lower prevalence of symptoms and signs of volume overload compared to patients hospitalized in other months. Atrial arrhythmias were significantly less frequent and cholesterol levels were significantly lower in Ramadan. Hospitalization in Ramadan was not independently associated with increased immediate or 1-year mortality. CONCLUSIONS The current study represents the largest evaluation of the effects of fasting on AHF. It reports an improved volume status in fasting patients. There were also favorable effects on atrial arrhythmia and total cholesterol and no effects on immediate or long-term outcomes.
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Affiliation(s)
- Amar M Salam
- a Adult Cardiology , Hamad Medical Corporation , Doha , Qatar
| | | | - Alawi A Alsheikh-Ali
- c College of Medicine , Mohammed Bin Rashid University of Medicine and Health Sciences , Dubai , United Arab Emirates
- d Institute of Cardiac Sciences , Sheikh Khalifa Medical City , Abu Dhabi , United Arab Emirates
| | - Rajvir Singh
- e Biostatistics Section, Cardiovascular Research , Heart Hospital, Hamad Medical Corporation , Doha , Qatar
| | - Nidal Asaad
- a Adult Cardiology , Hamad Medical Corporation , Doha , Qatar
| | - Awad Al-Qahtani
- a Adult Cardiology , Hamad Medical Corporation , Doha , Qatar
| | - Imtiaz Salim
- a Adult Cardiology , Hamad Medical Corporation , Doha , Qatar
| | - Khalid F AlHabib
- f Department of Cardiac Sciences , King Fahad Cardiac Center, King Saud University , Riyadh , Saudi Arabia
| | - Ibrahim Al-Zakwani
- g College of Medicine & Health Sciences, Department of Pharmacology & Clinical Pharmacy , Sultan Qaboos University, and Gulf Health Research , Oman
| | | | | | - Bassam Bulbanat
- h Department of Cardiology , Sabah Al-Ahmed Cardiac Center , Kuwait
| | | | - Nooshin Bazargani
- k Department of Cardiology , Dubai hospital , Dubai , United Arab Emirates
| | - Haitham Amin
- l Department of Cardiology , Mohammed Bin Khalifa Cardiac Center , Manamah , Bahrain
| | - Ahmed Al-Motarreb
- m Department of Cardiology, Faculty of Medicine , Sana'a University , Sana'a , Yemen
| | - Husam Al Faleh
- n Department of Cardiology and Cardiovascular Surgery , Security Forces Hospital , Riyadh , Saudi Arabia
| | - Hanan Albackr
- f Department of Cardiac Sciences , King Fahad Cardiac Center, King Saud University , Riyadh , Saudi Arabia
| | | | - Abdulla Shehab
- o Internal Medicine Department , College of Medicine and Health Sciences (CMHS), UAE University , United Arab Emirates
| | - Jassim Al Suwaidi
- a Adult Cardiology , Hamad Medical Corporation , Doha , Qatar
- p Qatar Cardiovascular Research Center , Doha , Qatar
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18
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Salim I, Al Suwaidi J, AlBinali HA, Singh R, Al-Qahtani A, Asaad N, Salam AM. Impact of Chronic Kidney Disease on the Presentation and Outcome of Patients Hospitalized With Atrial Fibrillation: Insights From Qatar. Angiology 2017; 69:212-219. [PMID: 28691505 DOI: 10.1177/0003319717717849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Atrial fibrillation (AF) with coexistent chronic kidney disease (CKD) is poorly described in the literature. We compared the presenting symptoms, clinical characteristics, treatment, and outcome of patients hospitalized with AF with and without CKD in a large clinical registry. Data of patients hospitalized with AF between 1991 and 2012 in Qatar were analyzed. Of 5201 patients hospitalized for AF, 264 (5.1%) had CKD. Patients with AF and CKD were older with higher prevalence of other comorbidities and left ventricular dysfunction and were more likely to present with shortness of breath and chest pain compared with patients with AF alone who were more likely to present with palpitation. The crude in-hospital mortality was 3 times higher in patients with dual disease. On multivariable adjustments, CKD was an independent predictor of mortality (odds ratio: 2.84; 95% confidence interval: 1.33-6.08, P = .001). Further studies are warranted to try to reduce the increased mortality observed in this high-risk population.
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Affiliation(s)
- Imtiaz Salim
- 1 Cardiology Section, Weill Cornell Medical College-Qatar, Al-Khor Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Jassim Al Suwaidi
- 2 Department of Cardiology, The Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hajar A AlBinali
- 2 Department of Cardiology, The Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- 2 Department of Cardiology, The Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Awad Al-Qahtani
- 2 Department of Cardiology, The Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Nidal Asaad
- 2 Department of Cardiology, The Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Amar M Salam
- 1 Cardiology Section, Weill Cornell Medical College-Qatar, Al-Khor Hospital, Hamad Medical Corporation, Doha, Qatar
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19
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Salam AM, AlBinali HA, Singh R, Al-Qahtani A, Asaad N, Al Suwaidi J. Gender Variations in In-Hospital Mortality in Patients Hospitalized With Dizziness: A Retrospective Study. Angiology 2017; 68:914-918. [PMID: 28387126 DOI: 10.1177/0003319717703225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Women with cardiac diseases generally have a higher mortality than men. Suggested reasons include delay in reporting to hospital, less aggressive management, and higher cardiovascular risk profiles in women. We assessed gender differences in patients hospitalized with dizziness. We retrospectively reviewed the database of patients hospitalized with acute cardiac disease in Qatar from 1991 to the end of 2010. Patients hospitalized with dizziness were analyzed; 1611 (3.8%; 95% confidence interval [CI]: 3.6%-4%) of the total N = 42 144 patients were hospitalized with dizziness during the 20 years: 410 (25.5%) females and 1201 (74.5%) males. Mean age (female 55 [16] and male 53 [16] years) was comparable ( P = .06). Women had more hypertension, diabetes mellitus, palpitation, and arrhythmia compared with men. In-hospital mortality was 3.8% (women 5.6% vs men 3.2%, P = .03). After adjusting for potential confounders, female gender remained an independent factor for increased in-hospital mortality (adjusted odds ratio: 2.2, 95% CI: 1.21-4, P = .01). In this 20-year data set from a Middle Eastern country, female gender was an independent factor associated with increased in-hospital mortality in patients hospitalized with dizziness after adjusting for confounders. Further research is warranted to confirm this novel gender difference.
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Affiliation(s)
- Amar M Salam
- 1 Department of Cardiology and Cardiovascular Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,2 Cardiology Section, Al-Khor Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hajar A AlBinali
- 1 Department of Cardiology and Cardiovascular Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,3 Department of Adult Cardiology, The Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- 3 Department of Adult Cardiology, The Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Awad Al-Qahtani
- 3 Department of Adult Cardiology, The Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Nidal Asaad
- 3 Department of Adult Cardiology, The Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Jassim Al Suwaidi
- 1 Department of Cardiology and Cardiovascular Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,3 Department of Adult Cardiology, The Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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20
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Ertekin E, van Hagen IM, Salam AM, Ruys TP, Johnson MR, Popelova J, Parsonage WA, Ashour Z, Shotan A, Oliver JM, Veldtman GR, Hall R, Roos-Hesselink JW. Corrigendum to ‘Ventricular tachyarrhythmia during pregnancy in women with heart disease: Data from the ROPAC, a registry from the European Society of Cardiology’ [Int. J. Cardiol. 220 (2016) 131–136]. Int J Cardiol 2017; 232:348. [DOI: 10.1016/j.ijcard.2017.01.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Salam AM, Sulaiman K, Al-Zakwani I, Alsheikh-Ali A, Aljaraallah M, Al Faleh H, Elasfar A, Panduranga P, Singh R, Abi Khalil C, Al Suwaidi J. Coronary artery disease prevalence and outcome in patients hospitalized with acute heart failure: an observational report from seven Middle Eastern countries. Hosp Pract (1995) 2016; 44:242-251. [PMID: 27737597 DOI: 10.1080/21548331.2016.1246945] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVES The purpose of this study was to report prevalence, clinical characteristics, precipitating factors, management and outcome of patients with coronary artery disease (CAD) among patients hospitalized with heart failure (HF) in seven Middle Eastern countries and compare them to non-CAD patients. METHODS Data were derived from Gulf CARE (Gulf aCute heArt failuRe rEgistry), a prospective multicenter study of 5005 consecutive patients hospitalized with acute HF during February-November 2012 in 7 Middle Eastern countries. RESULTS The prevalence of CAD among Acute Heart Failure (AHF) patients was 60.2% and varied significantly among the 7 countries (Qatar 65.7%, UAE 66.6%, Kuwait 68.0%, Oman 65.9%, Saudi Arabia 62.5%, Bahrain 52.7% and Yemen 49.1%) with lower values in the lower income countries. CAD patients were older and more likely to have diabetes, hypertension, dyslipidemia and chronic kidney disease. Moreover, CAD patients were more likely to have history of cerebrovascular and peripheral vascular disease when compared to non-CAD patients. In-hospital mortality rates were comparable although CAD patients had more frequent re-hospitalization and worse long-term outcome. However, CAD was not an independent predictor of poor outcome. CONCLUSION The prevalence of CAD amongst patients with HF in the Middle East is variable and may be related to healthcare sources. Regional and national studies are needed for assessing further the impact of various etiologies of HF and for developing appropriate strategies to combat this global concern.
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Affiliation(s)
- Amar M Salam
- a Department of Cardiology , Al-khor Hospital, Hamad Medical Corporation , Doha , Qatar
| | | | - Ibrahim Al-Zakwani
- c Department of Pharmacology & Clinical Pharmacy , Sultan Qaboos University , Muscat , Oman
| | - Alawi Alsheikh-Ali
- d College of Medicine , Mohammed Bin Rashid Medical University , Dubai , United Arab Emirates
| | | | - Husam Al Faleh
- f Department of Cardiology and Cardiovascular Surgery , King Saud University , Riyadh , Saudi Arabia
| | - Abdelfatah Elasfar
- g Department of Cardiology , Prince Salman Hospital , Riyadh , Saudi Arabia
| | | | - Rajvir Singh
- a Department of Cardiology , Al-khor Hospital, Hamad Medical Corporation , Doha , Qatar
| | - Charbel Abi Khalil
- h Department of Genetic Medicine and Department of Medicine , Weill Cornell Medical College in Qatar , Doha , Qatar
| | - Jassim Al Suwaidi
- i Department of Adult Cardiology and Cardiovascular Surgery , Heart Hospital, Hamad Medical Corporation , Doha , Qatar
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22
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Abstract
Acute myocardial infarction rarely occurs in women during pregnancy. However, when it does occur, it usually carries a high risk of maternal and perinatal mortality. There is a lack of awareness that this condition can occur in pregnancy since coronary artery disease is uncommon in women of childbearing age. In this report, a 43-year-old lady with acute anterior myocardial infarction in her eighth week of pregnancy is presented. The challenges involved in diagnosing this condition in pregnancy are briefly discussed.
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Affiliation(s)
- Amar M Salam
- Department of Cardiology & Cardiovascular Surgery, Hamad Medical Corporation, Doha, Qatar.
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23
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Ertekin E, van Hagen IM, Salam AM, Ruys TPE, Johnson MR, Popelova J, Parsonage WA, Ashour Z, Shotan A, Oliver JM, Veldtman GR, Hall R, Roos-Hesselink JW. Ventricular tachyarrhythmia during pregnancy in women with heart disease: Data from the ROPAC, a registry from the European Society of Cardiology. Int J Cardiol 2016; 220:131-6. [PMID: 27376569 DOI: 10.1016/j.ijcard.2016.06.061] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 06/19/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To describe the incidence, onset, predictors and outcome of ventricular tachyarrhythmia (VTA) in pregnant women with heart disease. BACKGROUND VTA during pregnancy will cause maternal morbidity and even mortality and will have impact on fetal outcome. Insufficient data exist on the incidence and outcome of VTA in pregnancy. METHODS AND RESULTS From January 2007 up to October 2013, 99 hospitals in 39 countries enrolled 2966 pregnancies in women with structural heart disease. Forty-two women (1.4%) developed clinically relevant VTA during pregnancy, which occurred mainly in the third trimester (48%). NYHA class >1 before pregnancy was an independent predictor for VTA. Heart failure during pregnancy was more common in women with VTA than in women without VTA (24% vs. 12%, p=0.03) and maternal mortality was respectively 2.4% and 0.3% (p=0.15). More women with VTA delivered by Cesarean section than women without VTA (68% vs. 47%, p=0.01). Neonatal death, preterm birth (<37weeks), low birthweight (<2500g) and Apgar score <7 occurred more often in women with VTA (4.8% vs. 0.3%, p=0.01; 36% vs. 16%, p=0.001; 33% vs. 15%, p=0.001 and 25% vs. 7.3%, p=0.001, respectively). CONCLUSIONS VTA occurred in 1.4% of pregnant women with cardiovascular disease, mainly in the third trimester, and was associated with heart failure during pregnancy. NYHA class before pregnancy was predictive. VTA during pregnancy had clear impact on fetal outcome.
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Affiliation(s)
- Ebru Ertekin
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | - Amar M Salam
- Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Titia P E Ruys
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Mark R Johnson
- Imperial College School of Medicine, Chelsea and Westminster Hospital, London, United Kingdom
| | - Jana Popelova
- Hospital Na Homolce & Pediatric Heart Center University Hospital Motol, Prague, Czech Republic
| | | | | | | | - José M Oliver
- Adult Congenital Heart Disease Unit, La Paz University Hospital, Madrid, Spain
| | - Gruschen R Veldtman
- Adolescent and Adult Congenital Heart Program, Cincinnati Children's Hospital, Cincinnati,United States
| | - Roger Hall
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Jolien W Roos-Hesselink
- Erasmus University Medical Center, Rotterdam, The Netherlands; Fellow of the European Society of Cardiology, Sophia Antipolis Cedex, France.
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24
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Hasan OF, Al Suwaidi J, Omer AA, Ghadban W, Alkilani H, Gehani A, Salam AM. The influence of female gender on cardiac arrest outcomes: a systematic review of the literature. Curr Med Res Opin 2014; 30:2169-78. [PMID: 24940826 DOI: 10.1185/03007995.2014.936552] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Sudden cardiac arrest is an important cause of cardiovascular mortality. The impact of gender on the outcome of cardiac arrest is not clear and data about that is limited. OBJECTIVE Understanding the influence of gender on cardiac arrest through a systematic review of the published literature. METHODS A search of all published studies in English between January 1970 and May 2013 was performed using the electronic databases PubMed and MEDLINE, using the key words 'cardiac arrest', 'outcome', and 'gender'. RESULTS Eleven studies were included in this review, all of which were observational studies conducted using national-based database registries of cardiac arrest. A total of 548,440 patients were enrolled in these studies with 220,646 (40.3%) of them being female patients. In general, there was a lower percentage of women in the reported studies compared to men. Women were older in age and more likely to have non-shockable rhythms as the initial rhythm. Women also had a lower rate of witnessed arrest, a lower rate of bystander resuscitation, a higher rate of survival until hospital admission and a lower rate of in-hospital survival compared to men. Women also had a more favorable one month survival and neurological outcome. CONCLUSION In the reported literature female gender seems to offer survival and outcome advantages following out-of-hospital cardiac arrest over male gender. This is in contrast to most other aspects of heart disease in which women tend to have a worse prognosis.
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Affiliation(s)
- Omar F Hasan
- Cardiology Section, Al-Khor Hospital, Hamad Medical City , Doha , Qatar
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25
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Salam AM, Gersh BJ, AlBinali HA, Singh R, Asaad N, Al-Qahtani A, Suwaidi JA. The prognostic implications of lack of palpitations in patients hospitalised with atrial fibrillation: observations from a 20-year registry. Int J Clin Pract 2014; 68:122-9. [PMID: 24341306 DOI: 10.1111/ijcp.12230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 06/06/2013] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES It is well recognised that patients differ in the clinical presentation of atrial fibrillation (AF), ranging from the typical symptom of palpitations, atypical symptoms in others and a substantial that are asymptomatic. Whether the different patterns of presentation are associated with differences in outcomes is not known. The aim of this study was to evaluate the prevalence and the prognostic implications of lack of palpitations among patients hospitalised with AF in a large prospective registry. METHODS Retrospective analysis of all patients hospitalised with AF in Qatar from 1991 to 2010 was made. Patients were divided into two groups according to the presence or absence of palpitations on presentation. Clinical characteristics and outcome were analysed. RESULTS During the 20-year period, 3850 patients were hospitalised for AF; 1724 (44.8%) had palpitations on presentation while 2126 (55.2%) had no palpitations. Patients who lacked palpitations were 9 years older, had a higher prevalence of diabetes mellitus (64.7% vs. 35.3%), underlying coronary artery disease (CAD; 14.6% vs. 6.2%) and severe left ventricular dysfunction on echocardiography (25.5% vs. 6.6%), (all, p = 0.001). There were 141 deaths among the group with no palpitations compared with 19 among the group with palpitations (6.6% vs. 1.1%). Multivariate analysis of mortality predictors identified 'lack of palpitations' as an independent predictor of in-hospital mortality (relative risk 5.56; 95% confidence interval 1.20-25.0, p = 0.03). CONCLUSIONS Our study demonstrates for the first time that lack of palpitations as the presenting symptom of patients with AF is associated with worse in-hospital outcome independent of other risk factors or therapy. The underlying mechanisms and the role of confounders warrant further investigation.
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Affiliation(s)
- A M Salam
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Doha, Qatar
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Hassan OF, Al Suwaidi J, Salam AM. Anti-Arrhythmic Agents in the Treatment of Atrial Fibrillation. J Atr Fibrillation 2013; 6:864. [PMID: 28496859 DOI: 10.4022/jafib.864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 04/28/2013] [Accepted: 04/29/2013] [Indexed: 11/10/2022]
Abstract
Although atrial fibrillation (AF) is the most common sustained arrhythmia seen during daily cardiovascular physician practice, its management remained a challenge for cardiology physician as there was no single anti-arrhythmic agents proved to be effective in converting atrial fibrillation and kept its effectiveness in maintaining sinus rhythm over long term. Moreover all the anti-arrhythmic agents that are used in treatment of AF were potentially pro-arrhythmic especially in patients with coronary artery disease and structurally abnormal heart. Some of these drugs also have serious non cardiac side effects that limit its long term use in the management of atrial fibrillation. Several new and investigational anti-arrhythmic agents are emerging but data supporting their effectiveness and safety are still limited. In this systematic review we examine the efficacy and safety of these medications supported by the major published randomized trials, meta-analyses and review articles and conclude with a summary of guidelines recommendations.
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Affiliation(s)
- Omar F Hassan
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Qatar
| | - Jassim Al Suwaidi
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Qatar
| | - Amar M Salam
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Qatar
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Salam AM, AlBinali HA, Salim I, Singh R, Asaad N, Al-Qahtani A, Al Suwaidi J. Impact of religious fasting on the burden of atrial fibrillation: a population-based study. Int J Cardiol 2013; 168:3042-3. [PMID: 23642825 DOI: 10.1016/j.ijcard.2013.04.131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 04/06/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Amar M Salam
- Department of Cardiology and Cardiovascular Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar; Cardiology Section, Al-Khor Hospital, Hamad Medical Corporation, Doha, Qatar
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Salam AM, Al Binali HA, Singh R, Gehani A, Asaad N, Al-Qahtani A, Al Suwaidi J. Atrial fibrillation in Middle Eastern Arab and South Asian patients hospitalized with acute myocardial infarction: experience from a 20-year registry in qatar (1991-2010). Acta Cardiol 2013; 68:173-80. [PMID: 23705560 DOI: 10.1080/ac.68.2.2967275] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Recent evidence suggests that there are ethnic variations in atrial fibrillation (AF) susceptibility and incidence following acute myocardial infarction (AMI). OBJECTIVES The aim of this study was to evaluate the incidence and predictors of AF in the setting of AMI in Middle Eastern Arab and South Asian patients and its impact on in-hospital morbidity and mortality. METHODS A retrospective analysis of a prospective registry of all patients hospitalized with AMI in the state of Qatar from 1991 through 2010 was made. Clinical characteristics and outcomes of AMI patients with and without AF were compared. Sub-analysis according to ethnicity was also performed. RESULTS During the 20-year period; a total of 12,881 patients were hospitalized with AMI. Of these 5028 were Arabs and 5985 were South Asians. A total of 227 had AF during hospitalization with an overall incidence of 1.8% (156 Arabs; incidence 3.1% and 48 South Asians; incidence 0.8%). The mean age of AF patients was 65 years (Arabs 69, South Asians 54). Patients with AF were significantly older and had more cardiovascular co-morbidities than patients without AF, and were more likely to have non-ST elevation AMI on presentation. Patients with AF had significantly higher in-hospital mortality rate (20.3% versus 7.1%; P=0.001) and stroke rates (1.8% versus 0.3%; P=0.001) when compared to patients without AF. Age was the only independent predictor of AF development in patients with AMI in our study. CONCLUSIONS Our study reports variability in the prevalence of AF among AMI patients according to ethnicity using a 20-year registry from a Middle Eastern country. Advancing age was the major independent predictor of AF in our AMI patients. Further prospective studies are required evaluating optimal therapeutic approaches for these high-risk patients in order to reduce the high mortality observed.
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Affiliation(s)
- Amar M. Salam
- Dept. of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Qatar
| | - Hajar A. Al Binali
- Dept. of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Qatar
| | - Rajvir Singh
- Dept. of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Qatar
| | - Abdurrazzak Gehani
- Dept. of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Qatar
| | - Nidal Asaad
- Dept. of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Qatar
| | - Awad Al-Qahtani
- Dept. of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Qatar
| | - Jassim Al Suwaidi
- Dept. of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Qatar
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Abstract
BACKGROUND Fasting during the month of Ramadan is a religious obligation that is practiced by millions of people around the world yet there is no clear scientific consensus on its effects on cardiovascular disease. This study was performed to inform physicians as well as patients of evidence based recommendations on this subject. AIM The study was undertaken to assess: (1) any alteration in the incidence of acute cardiac illness during Ramadan fasting; (2) whether fasting during the month of Ramadan alters the clinical status of patients with stable cardiac disease; and (3) the impact of Ramadan fasting on cardiovascular risk factors in normal subjects, in patients with stable cardiac disease, metabolic syndrome, dyslipidemia, type 2 diabetes and systemic hypertension. STUDY DESIGN Systematic review of the literature. METHOD A Medline search of the English literature published between January 1980 and September 2012. RESULTS The incidence of acute cardiac illness during Ramadan fasting was similar to non-fasting days, although the timing of symptom onset may be different, with significant increase in events during the period of 'breaking fast' when compared to non-fasting days. The majority of patients with stable cardiac illness can undergo Ramadan fasting without any clinical deterioration. Body mass index, lipid profile, and blood pressure showed significant improvement in normal healthy subjects, patients with stable cardiac illness, metabolic syndrome, dyslipidemia and hypertension during Ramadan fasting. The lipid profile of diabetic patients deteriorated significantly during Ramadan fasting. CONCLUSIONS Ramadan fasting is not associated with any change in incidence of acute cardiac illness and the majority of cardiac patients can fast without any difficulty. Improvement in lipid profile, especially 30% to 40% increment in high-density lipoprotein, as reported in some studies, appear promising. Diabetic patients should be carefully monitored during Ramadan fasting.
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Salam AM, AlBinali HA, Al-Sulaiti EM, Al-Mulla AW, Singh R, Al Suwaidi J. Effect of age on treatment, trends and outcome of patients hospitalized with atrial fibrillation: insights from a 20-years registry in a Middle-Eastern country (1991-2010). Aging Clin Exp Res 2012; 24:682-90. [PMID: 23211770 DOI: 10.3275/8757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Most studies on atrial fibrillation (AF) epidemiology, treatment, and outcomes have included mainly Caucasians patients. The world literature on AF in other ethnicities is very limited particularly in the elderly. AIMS The aim of this study was to compare the clinical characteristics, treatment and outcome of elderly and younger patients hospitalized with AF in a Middle-Eastern country and examine the trends of AF etiologies over a 20-year period. METHODS A retrospective analysis of a prospective registry of all patients hospitalized with AF in Qatar from 1991 through 2010 was made. Patients were divided into three groups; group 1: patients ≤50 years old, group 2: patients between 51 and 70 years old, and group 3: patients >70 years old. Clinical characteristics, management, and outcomes of AF patients were compared according to age. RESULTS Between the year 1991 and the end of 2010, a total 3848 consecutive patients were admitted with AF. One thousand three hundred and forty-five patients were ≤50 years, 1759 were between 51 and 70 years and 744 patients were >70 years old. Elderly patients were more likely to have hypertension and chronic renal impairment. There was a higher prevalence of associated coronary artery disease and aortic stenosis in elderly patients with a lower left ventricular ejection fraction than the younger age groups. A lower use of anticoagulation in the elderly group was observed but there was no underuse of other evidence-based medications. The older AF patients had significantly higher in-hospital mortality and stroke rates with no significant changes in mortality trends over the 20 years of study. An increasing trend of the associated acute coronary syndromes, hypertension and diabetes mellitus prevalence was observed in the elderly group. CONCLUSION Anticoagulation remains underutilized in elderly patients with AF despite proven efficacy and increasing trends of cardiovascular comorbidities. The current study underscores the urgent need for prospective studies to investigate warfarin contraindications, relative warfarin efficacy and bleeding risks in our region to help guide healthcare providers in warfarin prescribing in this frail patient population and consequently reduce the risk of AF-related disabling strokes and mortality.
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Affiliation(s)
- Amar M Salam
- Cardiology and Cardiovascular Surgery Department, Doha, Qatar
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Salim I, Al Suwaidi J, Ghadban W, Salam AM. Anticoagulation in atrial fibrillation and co-existent chronic kidney disease: efficacy versus safety. Expert Opin Drug Saf 2012; 12:53-63. [DOI: 10.1517/14740338.2013.732569] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Salam AM, AlBinali HA, Al-Mulla AW, Singh R, Suwaidi JA. Secular Trends, Treatments, and Outcomes of Middle Eastern Arab and South Asian Patients Hospitalized With Atrial Fibrillation. Angiology 2012; 64:498-504. [DOI: 10.1177/0003319712460332] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A prospective registry was made of all patients hospitalized with atrial fibrillation (AF) in the State of Qatar from 1991 to 2010. Clinical characteristics, management, and outcomes were compared according to ethnicity (Middle Eastern Arab vs South Asian). During this 20-year period, 2857 Arabs and 548 Asians were hospitalized for AF. Arabs were 9 years older and more likely to have hypertension, diabetes mellitus (DM), chronic renal impairment, and dyslipidemia than the Asians. Valvular heart disease and acute coronary syndromes were more common among Asians, while congestive heart failure was more common in Arabs. The overall inhospital mortality was lower in Asians than that of Arabs, while stroke rates were comparable. There was an increase in the prevalence of DM and hypertension in both the groups in the latter years of the study period, but there was no change in mortality trends. Our findings underscore the need to study AF according to ethnicity.
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Affiliation(s)
- Amar M. Salam
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Hajar A. AlBinali
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Abdul Wahid Al-Mulla
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Doha, Qatar
| | - Jassim Al Suwaidi
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Doha, Qatar
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Al Suwaidi J, Al Habib K, Asaad N, Singh R, Hersi A, Al Falaeh H, Al Saif S, Al-Motarreb A, Almahmeed W, Sulaiman K, Amin H, Al-Lawati J, Al-Sagheer NQ, Alsheikh-Ali AA, Salam AM. Immediate and one-year outcome of patients presenting with acute coronary syndrome complicated by stroke: findings from the 2nd Gulf Registry of Acute Coronary Events (Gulf RACE-2). BMC Cardiovasc Disord 2012; 12:64. [PMID: 22894647 PMCID: PMC3480946 DOI: 10.1186/1471-2261-12-64] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2011] [Accepted: 08/09/2012] [Indexed: 11/18/2022] Open
Abstract
Background Stroke is a potential complication of acute coronary syndrome (ACS). The aim of this study was to identify the prevalence, risk factors predisposing to stroke, in-hospital and 1-year mortality among patients presenting with ACS in the Middle East. Methods For a period of 9 months in 2008 to 2009, 7,930 consecutive ACS patients were enrolled from 65 hospitals in 6 Middle East countries. Results The prevalence of in-hospital stroke following ACS was 0.70%. Most cases were ST segment elevation MI-related (STEMI) and ischemic stroke in nature. Patients with in-hospital stroke were 5 years older than patients without stroke and were more likely to have hypertension (66% vs. 47.6%, P = 0.001). There were no differences between the two groups in regards to gender, other cardiovascular risk factors, or prior cardiovascular disease. Patients with stroke were more likely to present with atypical symptoms, advanced Killip class and less likely to be treated with evidence-based therapies. Independent predictors of stroke were hypertension, advanced killip class, ACS type –STEMI and cardiogenic shock. Stroke was associated with increased risk of in-hospital (39.3% vs. 4.3%) and one-year mortality (52% vs. 12.3%). Conclusion There is low incidence of in-hospital stroke in Middle-Eastern patients presenting with ACS but with very high in-hospital and one-year mortality rates. Stroke patients were less likely to be appropriately treated with evidence-based therapy. Future work should be focused on reducing the risk and improving the outcome of this devastating complication.
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Affiliation(s)
- Jassim Al Suwaidi
- Department of Cardiology, Hamad Medical Corporation (HMC), Doha, Qatar.
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Abstract
The proprotein convertase subtilisin kexin 9 (PCSK9) is a serine protease that has recently emerged as a potential target for the treatment of hypercholesterolemia. SAR236553/REGN727 is a highly specific monoclonal antibody to PCSK9 that significantly reduced LDL cholesterol levels in healthy volunteers and in subjects with hypercholesterolemia in three Phase-I studies. It was subsequently tested in a recent Phase-II study in patients with primary hypercholesterolemia with impressive results. In this report the trial is discussed along with the significance of the results in guiding further research in PCSK9 inhibition.
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Das KM, El-Menyar AA, Salam AM, Singh R, Dabdoob WAK, Albinali HA, Al Suwaidi J. Contrast-enhanced 64-Section Coronary Multidetector CT Angiography versus Conventional Coronary Angiography for Stent Assessment. Radiology 2007; 245:424-32. [PMID: 17890354 DOI: 10.1148/radiol.2452061389] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To prospectively evaluate the accuracy of 64-section computed tomography (CT) for diagnosis of stent restenosis, by using conventional coronary angiography as the reference standard. MATERIALS AND METHODS The ethics committee granted permission for the study; patients gave written consent. Contrast material-enhanced coronary CT angiography was performed in 53 patients (45 men, eight women; mean age, 54 years +/- 9 [standard deviation]) suspected of having stent restenosis. Coronary CT angiographic findings were compared with conventional coronary angiographic findings. Two physicians analyzed coronary CT angiographic data sets with multiplanar reformatted images and three-dimensional reformations by using a volume-rendering technique and looked for stent detectability, low-attenuation in-stent filling defects, and grades of restenosis. Conventional coronary angiographic results were interpreted by one of several observers in consensus for stent restenosis; they were blinded to coronary CT angiographic data. Statistical software and general estimating equations were used for data analysis. RESULTS One hundred ten stents were identified in 53 patients. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of coronary CT angiography in detection of in-stent restenosis were 96.9%, 88.0%, 77.5%, 98.5%, and 91%, respectively. Coronary CT angiography depicted in-stent low-attenuation filling defects with an accuracy of 91% and negative predictive value of 98.5% (95% confidence interval: 90.9, 99.9). Coronary CT angiography depicted the status of 97 of 107 stents. There was no significant difference between in-stent lumen visibility and stent diameter (P = .104). Coronary CT angiography helped diagnose 15 of 18 stent restenoses with less than 50% narrowing, five of five stent restenoses with 50%-74% narrowing, and nine of nine (100%) stent restenoses with 75% or greater narrowing or total occlusion of the stent lumen. CONCLUSION Coronary CT angiography can depict in-stent low-attenuation filling defects, which appear to be a reliable sign of stent restenosis, and 64-section CT depicts such defects with a high degree of accuracy.
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Affiliation(s)
- K M Das
- Departments of Radiology, Cardiology, and Medical Research, Hamad Medical Corporation, Hamad Medical St, Doha, Qatar.
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Abstract
The introduction and widespread use of coronary stents have been the most important advancement in the percutaneous treatment of coronary artery disease since the introduction of balloon angioplasty. Coronary artery stents reduce the rate of angiographic and clinical restenosis compared to balloon angioplasty. This angiographic restenosis was further reduced with the introduction of drug-eluting stents and hence further reduction in the frequency of major adverse cardiac events. Herein we present a comprehensive and up-to-date review about the use of drug-eluting stents in the treatment of coronary artery disease.
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Salam AM, Al Suwaidi J. Evolving role of clopidogrel in acute coronary syndromes. Expert Rev Cardiovasc Ther 2005; 3:977-80. [PMID: 16292986 DOI: 10.1586/14779072.3.6.977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Salam AM, Al Suwaidi J. Selected highlights from the 54th annual scientific session of the American College of Cardiology, Orlando, USA, 6-9 March 2005. Expert Opin Pharmacother 2005; 6:1425-36. [PMID: 16013992 DOI: 10.1517/14656566.6.8.1425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The recent scientific session of the American College of Cardiology, held in Orlando, Florida, US, was one of the largest gatherings in the field of cardiovascular medicine worldwide. This year's session provided a wealth of new information in many areas of cardiovascular medicine and the results of several clinically relevant new trials and current challenges facing cardiology were presented. Provided here are selected highlights that have important implications for clinical practice.
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Affiliation(s)
- Amar M Salam
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
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Abstract
Hospitalisation of patients presenting with deteriorating congestive heart failure is occurring with increasing frequency and is associated with significant morbidity and mortality. Diuretic use, the mainstay therapy for congestion, is associated with electrolyte abnormalities and deteriorating renal function. In a recent randomised study, tolvaptan, a novel vasopressin antagonist, in addition to standard therapy including diuretics, increased net fluid loss resulting in decreased body weight more effectively than standard therapy alone in patients hospitalised for heart failure. This desirable effect was achieved without adversely affecting blood pressure, heart rate, electrolyte levels, or renal function. Although tolvaptan did not reduce the rate of deteriorating heart failure after discharge, post hoc analysis suggested that mortality might be reduced in high-risk patients treated with tolvaptan. These results make an important contribution to heart failure research, and offer an insight into the future role of vasopressin antagonism in the treatment of congestive heart failure.
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Affiliation(s)
- Amar M Salam
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
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Salam AM. The benefits of abciximab questioned in percutaneous coronary interventions following pretreatment with high-dose clopidogrel. Expert Opin Investig Drugs 2005; 14:335-8. [PMID: 15833064 DOI: 10.1517/13543784.14.3.335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Amar M Salam
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, P.O.Box 3050, Doha, Qatar.
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Salam AM, Al-Mousa EN. The therapeutic potential of ximelagatran to become the anticoagulant of choice in medicine: a review of recently completed clinical trials. Expert Opin Pharmacother 2005; 5:1423-30. [PMID: 15163285 DOI: 10.1517/14656566.5.6.1423] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Ximelagatran (Exanta, AstraZeneca) is a novel oral direct thrombin inhibitor that inhibits the final step in the coagulation process - namely, the conversion of fibrinogen to insoluble fibrin by thrombin. Recently completed large clinical trials have evaluated the efficacy and safety of ximelagatran compared to standard anticoagulation therapy with warfarin and heparins in several thrombotic disorders including the treatment and prevention of venous thromboembolism following major orthopaedic surgery; stroke prevention in atrial fibrillation; and after acute myocardial infarction. This article reviews these recent clinical trials and explores the therapeutic potential of ximelagatran to become the oral anticoagulant of first choice in medicine.
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Affiliation(s)
- Amar M Salam
- Hamad Medical Corporation, Department of Cardiology and Cardiovascular Surgery, PO Box 3050, Doha, Qatar.
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Abstract
Current international guidelines recommend that the goal of treatment with lipid-lowering therapy in patients with established coronary artery disease (CAD) should be a low-density lipoprotein cholesterol level of < 100 mg/dl. The question that remains to be answered is whether more aggressive lowering of low-density lipoprotein cholesterol levels below this target offers additional benefit and whether it can be tolerated. Two recently published related studies addressed this question by comparing intensive lipid lowering with atorvastatin (Lipitor, Pfizer) 80 mg/day with a moderate lipid-lowering regimen of pravastatin (Pravachol, Bristol-Myers Squibb) 40 mg/day. The first study, the Reversing Atherosclerosis with Aggressive Lipid Lowering (REVERSAL) compared the effect of the two regimens on coronary artery atheroma burden and progression using intravascular ultrasound in patients with symptomatic CAD. The second study, the Pravastatin or Atorvastatin Evaluation and Infection Therapy (PROVE-IT) was a clinical outcome trial in patients recently hospitalised with acute coronary syndromes. This article reviews the implications of these two studies in the management of patients with CAD. In addition, other ongoing trials and future directions are explored.
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Affiliation(s)
- Amar M Salam
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, PO Box 3050, Doha, Quatar.
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Salam AM. Lipid-lowering therapy in patients with average cholesterol and high cardiovascular risk, insights from the Heart Protection Study. Cardiovasc Drugs Ther 2005; 18:387-9. [PMID: 15717141 DOI: 10.1007/s10557-005-5063-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although the benefits of cholesterol-lowering with statins has been established for patients with high cholesterol levels as well as for patients with prior occlusive coronary heart disease, substantial uncertainty has existed about the long-term benefits of these agents in particular types of patient, including patients with moderate or low baseline cholesterol levels pre-treatment, women, the elderly, and those with prior occlusive non-coronary vascular disease. The Heart Protection Study was designed to resolve these uncertainties and to provide substantially more safety information of statins. In this report the study is presented with the significance and practical implications of the results briefly discussed.
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Affiliation(s)
- Amar M Salam
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
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Al Suwaidi J, Bener A, Suliman A, Hajar R, Salam AM, Numan MT, Al Binali HA. A population based study of Ramadan fasting and acute coronary syndromes. Heart 2004; 90:695-6. [PMID: 15145888 PMCID: PMC1768280 DOI: 10.1136/hrt.2003.012526] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Al Suwaidi J, Holmes DR, Salam AM, Lennon R, Berger PB. Impact of coronary artery stents on mortality and nonfatal myocardial infarction: meta-analysis of randomized trials comparing a strategy of routine stenting with that of balloon angioplasty. Am Heart J 2004; 147:815-22. [PMID: 15131536 DOI: 10.1016/j.ahj.2003.11.025] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND A strategy of routine stenting has been shown to reduce the need for target-vessel revascularization compared with a strategy of balloon angioplasty alone; however, the impact on mortality and frequency of nonfatal myocardial infarction is unclear. The aim of this study was to provide a quantitative comparison of the impact of coronary stenting on the rates of mortality and myocardial infarction with that of balloon angioplasty with provisional stenting. METHODS We performed a meta-analysis of randomized trials comparing routine coronary stenting to percutaneous transluminal coronary angioplasty (PTCA), including only those trials that used combination antiplatelet therapy (aspirin and a thienopyridine) as an adjuvant to stenting. Such trials included: the Belegian Netherlands Stent Study (BENESTENT) II, Optimal Coronary Balloon Angioplasty With Provisional Stenting Versus Primary Stent (OCBAS), Balloon Optimization vs Stent Study (BOSS), Evaluation of Platelet IIb/IIIa Inhibitor for Stenting (EPISTENT), Optimum Percutaneous Transluminal Coronary Angioplasty Compared With Routine Stent Strategy (OPUS-1), French Optimal Stenting Trial (FROST), Angioplasty or Stent (AS), and Doppler Endpoint Stenting International Investigation (DESTINI) trials for de novo coronary artery lesions; the Stent vs Percutaneous Angioplasty in Chronic Total Occlusion (SPACTO), Total Occlusion Study of Canada (TOSCA), Stent or Angioplasty after Recanalization of Chronic Coronary Occlusions (SARECCO), and Mayo-Japan Investigation for Chronic Total Occlusion (MAJIC) trials for coronary occlusions; the Primary Angioplasty Versus Stent Implantation in Acute Myocardial Infarction (PASTA), Gianturco-Roubin in Acute Myocardial Infarction (GRAMI), Florence Randomized Elective Stenting in Acute Coronary Occlusions (FRESCO), Immediate Coronary Angioplasty with Elective Wiktor Stent Implantation Compared with Conventional Balloon Angioplasty in Acute Myocardial Infarction (STENTUIM-2), Stent Primary Angioplasty in MI (Stent-PAMI), Zwolle, and Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trials for acute ST-segment elevation myocardial infarction; and the Intracoronary Stenting or Angioplasty for Restenosis Reduction in Small Arteries (ISAR-SMART), Park, Stenting in Small Arteries (SISA), and Bestent in Small Arteries (BESMART) trials for small vessels. RESULTS The 23 trials enrolled 10,347 patients, with 5130 patients randomized to receive stent and 5217 patients randomized to receive balloon angioplasty. A total of 902 (17 %) of patients crossed over from a strategy of balloon angioplasty to stent placement because of the inability to achieve a satisfactory result with a balloon. No significant difference was observed between the stent group and PTCA group in the rates of death or myocardial infarction, despite a significant reduction in the frequency of major adverse cardiac events (odds ratio, 0.59; 95% CI, 0.50-0.70; P <.001), which was driven entirely by a reduction in target vessel revascularization. CONCLUSIONS An initial strategy of stent placement versus balloon angioplasty with provisional stenting is associated with a similar mortality rate and frequency of nonfatal myocardial infarction after a mean follow-up period of 12.8 months. Patients who underwent stent placement had a significantly lower risk of major adverse cardiac events only when target revascularization is included as an end point.
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Affiliation(s)
- Jassim Al Suwaidi
- Department of Cardiology and Cardiovascular Surgery, Hamad General Hospital and Hamad Medical Corporation, Doha, Qatar
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Salam AM. Angiotensin receptor blockers in acute myocardial infarction. Expert Opin Investig Drugs 2004; 13:427-30. [PMID: 15102591 DOI: 10.1517/13543784.13.4.427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
It has been established from multiple randomised, placebo-controlled trials that angiotensin-converting enzyme inhibitors reduce the risk of death and major non-fatal cardiovascular events after acute myocardial infarction, especially when these agents are used for long-term treatment in high-risk patients. Angiotensin receptor blockers represent a theoretically appealing class of drugs for use in combination with or as alternatives to angiotensin-converting enzyme inhibitors in such patients. The Valsartan in Acute Myocardial Infarction (VALIANT) trial compared the effects of valsartan, captopril and the combination of both in a population of high-risk patients with evidence of left ventricular dysfunction after acute myocardial infarction. This article discusses this important study and its implications for the clinical management of these high-risk patients.
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Affiliation(s)
- Amar M Salam
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Doha, Qatar.
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Abstract
To our knowledge, acute myocardial infarction after jellyfish envenomation has not been reported previously. We describe a previously healthy 45-year-old male diver who had an acute inferior myocardial infarction with right ventricular involvement after a jellyfish sting on his left forearm while diving in the Gulf Sea. The patient had a normal controlled ascent after the incident. He had no risk factors for coronary artery disease, and cardiac catheterization revealed normal coronary arteries. Acute myocardial infarction should be considered in patients who experience chest pain or have hemodynamic compromise after jellyfish envenomation.
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Affiliation(s)
- Amar M Salam
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Doha, Sate of Qatar
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Affiliation(s)
- Amar M Salam
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, Doha, Qatar.
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Salam AM. Is there a role for oral blockade of platelet glycoprotein IIb/IIIa receptors in coronary and cerebrovascular disease? Expert Opin Investig Drugs 2003; 12:1709-12. [PMID: 14519089 DOI: 10.1517/13543784.12.10.1709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The success of intravenous platelet glycoprotein (GP) IIb/IIIa receptor blockers as potent antithrombotic therapies has ignited interest in the research and development of oral agents with the intention of extending the initial clinical benefits proven with intravenous GP IIb/IIIa blockers to long-term care with the use of oral agents. Nonetheless, results of the recently published Blockade of the Glycoprotein IIb/IIIa Receptor to Avoid Vascular Occlusion (BRAVO) trial support the disappointing results of the earlier published studies, which revealed that the use of oral GP IIb/IIIa inhibitors was associated with an unacceptable increased mortality. Further research to elucidate the mechanism of this increased fatality risk is warranted before any further clinical studies with the oral GP IIb/IIIa inhibitors can be ethically justified.
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Affiliation(s)
- Amar M Salam
- Department of Cardiology and Cardiovascular Surgery, Hamad Medical Corporation, PO Box 3050, Doha, Qatar.
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