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Taha A, Ali S, Atti L, Duhan S, Elseidy S, Khir F, Keisham B, Aziz S, Spaseski M, Erdem S, ElJack A, Almas T, Uppal D, Ali S, Alraies MC. Cardiovascular Outcomes and Readmissions of Atrial Fibrillation Among Patent Foramen Ovale Occluder Device Recipients: A Propensity Matched National Readmission Study. Curr Probl Cardiol 2024; 49:102115. [PMID: 37802160 DOI: 10.1016/j.cpcardiol.2023.102115] [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] [Received: 09/27/2023] [Accepted: 09/30/2023] [Indexed: 10/08/2023]
Abstract
Patent foramen ovale (PFO) occluder devices are increasingly utilized in minimally invasive procedures used to treat cryptogenic stroke. Data on the impact of Atrial Fibrillation (AF) among PFO occluder device recipients are limited. The Nationwide Readmissions Database was queried between 2016 and 2019 to identify PFO patients with and without AF. The 2 groups were compared using propensity score matching (PSM) and multivariate regression models. The outcomes included in-hospital mortality, acute kidney injury (AKI), Mechanical circulatory support use (MCS), Cardiogenic shock (CS), acute ischemic stroke, bleeding, and other cardiovascular outcomes. Statistical analysis was performed using STATA v. 17. Out of 6508 Weighted hospitalizations for PFO occluder device procedure over the study period, 877 (13.4%) had AF compared to 5631 (86.6%) who did not. On adjusted analysis, PFO with AF group had higher rates of MCS (PSM, 4.5% vs 2.2 %, P value = 0.011) and SCA (PSM, 7.6% vs 4.6 %, P value = 0.015) compared to PFO with no AF. There was no statistically significant difference in the rate of in-hospital mortality (PSM, 5.4% vs 6.4 %, P value = 0.39), CS (PSM, 8.3% vs 5.9 %, P value = 0.075), AKI (PSM, 32.4% vs 32.3 %, P value = 0.96), bleeding (PSM, 2.08% vs 1.3%, P value = 0.235) or the readmission rates among both cohorts. Additionally, AF was associated with higher hospital length of stay (9.5 ± 13.2 vs 8.2 ± 24.3 days, P-value = 0.012) and total cost ($66,513 ± $80,922 vs $52,013±$125,136, 0.025, P-value = 0.025) compared to PFO without AF. AF among PFO occluder device recipients is associated with increased adverse outcomes, including MCS use and SCA, with no difference in mortality and readmission rates among both cohorts. Long-term follow-up needs further studies.
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Affiliation(s)
- Amro Taha
- Department of Internal Medicine, Weiss Memorial Hospital, Chicago, IL
| | - Shafaqat Ali
- Department of Internal Medicine, Louisiana State University, Shreveport, LA
| | - Lalitsiri Atti
- Department of Internal Medicine, Sparrow Hospital-Michigan State University, MI
| | - Sanchit Duhan
- Department of Internal Medicine, Sinai Hospital of Baltimore, Baltimore, MD
| | - Sheref Elseidy
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY
| | - Fadi Khir
- Department of Internal Medicine, Weiss Memorial Hospital, Chicago, IL
| | - Bijeta Keisham
- Department of Internal Medicine, Sinai Hospital of Baltimore, Baltimore, MD
| | - Sundal Aziz
- Department of Medicine, Khyber Medical University, Peshawar, Pakistan
| | - Maja Spaseski
- Department of Internal Medicine, Weiss Memorial Hospital, Chicago, IL
| | - Saliha Erdem
- Department of Internal Medicine, Wayne State University, Detroit Medical Center, MI
| | - Ammar ElJack
- Department of Cardiology, Baylor Scott and White Health, Heart Hospital Plano, TX
| | - Talal Almas
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Dipan Uppal
- Department of Cardiology, Cleveland Clinic, FL
| | - Shehzad Ali
- Department of Internal Medicine, Weiss Memorial Hospital, Chicago, IL
| | - M Chadi Alraies
- Department of Cardiology, Detroit Medical Center; Detroit, MI.
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Rahhal A, Mahfouz A, Khir F, Abdelghani M, Alkhalaila O, Aljundi A, Ashour A, Alahmad Y, Alyafei S, Arabi A. Impact of high-intensity statin therapy on glycemic control post-acute coronary syndrome using real-world data. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Statins use has been linked with increased risk of new onset diabetes and impaired glycemic control in the JUPITER trial and meta-analyses of randomized controlled trials. Nevertheless, the evidence is scarce in the real-world clinical settings, particularly among those receiving high-intensity statin post-acute coronary syndrome (ACS).
Methods
We conducted a retrospective observational study to determine the impact of statin use post-ACS on glycosylated hemoglobin (HbA1c) and the incidence of diabetes. The study included adults admitted with ACS between January 1, 2017 and December 31, 2018 and newly started on a high-intensity statin (rosuvastatin or atorvastatin). The outcomes assessed within 12 months of statin initiation were: (a) HbA1c before and after statin use among diabetic and non-diabetic patients; (b) incidence of diabetes. Paired sample t-test was used to compare HbA1c values pre and post statin use.
Results
Of the 1,253 patients included, 627 received rosuvastatin and 626 received atorvastatin following ACS. Most of the patients were Asian (77.3%), male (95.8%) with a median age of 51 years. The baseline HbA1c was 7.2±2.2% and 45% of the study population were diabetic at baseline. Among non-diabetic patients, statin use resulted in HbA1c increase from 5.7±0.7% to 6.0±0.8%, p<0.001, while among diabetic patients who were receiving treatment for diabetes, HbA1c decreased from 8.8±1.9% to 7.8±1.9%, p<0.001. New onset diabetes occurred in 41 (6%) of the non-diabetic patients, of whom 13 (1.9%) were receiving atorvastatin, while 28 (4.1%) were on rosuvastatin, p-value = 0.032. The use of both statins resulted in a significant increase of HbA1c among non-diabetic patients as demonstrated in Figure 1.
Conclusion
High intensity statin post-ACS was associated with increased HbA1c among non-diabetic patients. In particular, rosuvastatin significantly increased the new onset of diabetes compared to atorvastatin which might provide preference of atorvastatin use over rosuvastatin among non-diabetic patients post-acute coronary syndrome.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- A Rahhal
- Hamad Medical Corporation Heart Hospital , Doha , Qatar
| | - A Mahfouz
- Hamad Medical Corporation Heart Hospital , Doha , Qatar
| | - F Khir
- Hamad Medical Corporation , Doha , Qatar
| | - M Abdelghani
- Hamad Medical Corporation Heart Hospital , Doha , Qatar
| | - O Alkhalaila
- Hamad Medical Corporation Heart Hospital , Doha , Qatar
| | - A Aljundi
- Hamad Medical Corporation Heart Hospital , Doha , Qatar
| | - A Ashour
- Hamad Medical Corporation , Doha , Qatar
| | - Y Alahmad
- Hamad Medical Corporation Heart Hospital , Doha , Qatar
| | - S Alyafei
- Hamad Medical Corporation Heart Hospital , Doha , Qatar
| | - A Arabi
- Hamad Medical Corporation Heart Hospital , Doha , Qatar
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Rahhal A, Khir F, Orabi B, Chbib S, Al-Khalaila O, Abdelghani MS, Osman O, Ashour AA, Al-Awad M, Mahfouz A, Awaisu A, Aljundi AH, Alahmad Y, Alyafei S, Arabi AR. A Comparative Study of High-intensity Rosuvastatin Versus Atorvastatin Therapy Post-acute Coronary Syndrome Using Real-world Data. Curr Probl Cardiol 2021; 47:100956. [PMID: 34363847 DOI: 10.1016/j.cpcardiol.2021.100956] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 07/30/2021] [Indexed: 11/03/2022]
Abstract
A high-intensity statin is recommended for the secondary prevention of cardiovascular diseases (CVD). However, real-world evidence of the effectiveness of rosuvastatin following acute coronary syndrome (ACS) is scarce. This retrospective cohort study included patients diagnosed with ACS to compare between the 2 high-intensity statin therapies (rosuvastatin vs atorvastatin) in terms of a primary composite outcome of CVD-associated death, non-fatal ACS, and non-fatal stroke at 1 month and 12 months post discharge. The primary effectiveness outcome did not differ between the 2 groups at 1 month (1.3% vs 1%; aHR = 1.64, 95% CI 0.55-4.94, P= 0.379) and at 12 months (4.8% vs 3.5%; aHR = 1.48, 95% CI 0.82-2.67, P= 0.199). Similarly, the 2 groups had comparable safety outcomes. In conclusion, the use of high-intensity rosuvastatin compared to high-intensity atorvastatin therapy in patients with ACS had resulted in comparable cardiovascular effectiveness and safety outcomes.
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Affiliation(s)
- Alaa Rahhal
- Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
| | - Fadi Khir
- Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Bassant Orabi
- Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Salma Chbib
- Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Omnia Osman
- Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Ahmed Mahfouz
- Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Awaisu
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | | | - Yaser Alahmad
- Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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Chapra AF, Khir F, Alamami A, Salem KM, Yusof A. Neuropsychiatric Lupus: A Challenging Journey of a Patient With Pulmonary Tuberculosis. Cureus 2021; 13:e16018. [PMID: 34336508 PMCID: PMC8320408 DOI: 10.7759/cureus.16018] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2021] [Indexed: 11/24/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a disease that affects multiple systems in the body. Due to its variable manifestations, it can at times pose challenges for physicians to hold SLE as the culprit behind an affected system. This is most true when encountering patients with neuropsychiatric manifestations of SLE. We present a case of a 38-year-old female with known SLE limited to skin involvement and on treatment for active pulmonary tuberculosis (TB), yet otherwise healthy, who presented with acute fever associated with generalized tonic-clonic seizures. She was investigated for meningoencephalitis with a cerebrospinal fluid (CSF) analysis not being fully conclusive and with imaging features suggestive of viral encephalitis. However, despite receiving optimal care for causes of bacterial, viral, and tuberculous meningitis the patient continued to deteriorate and started to develop predominant psychiatric symptoms in the form of confusion and combative behavior requiring pharmacological restraint. Hence a trial of immunosuppressives was given with a presumptive diagnosis of neuropsychiatric lupus with IV methylprednisolone followed by a course of IV cyclophosphamide. However, this treatment proceeded with caution due to the fear of disseminated tuberculosis for which she did not show any sign of in the subsequent weeks. The patient showed modest clinical and radiological improvement and hence the treatment was continued. The case highlights the uncertainty that may precede a diagnosis of neuropsychiatric lupus and the challenges in treating it in patients with active mycobacterial infection.
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Affiliation(s)
| | - Fadi Khir
- Internal Medicine Residency Program, Medical Education, Hamad Medical Corporation, Doha, QAT
| | - Ans Alamami
- Critical Care, Hamad Medical Corporation, Doha, QAT
| | - Khaled M Salem
- Neuroradiology Section, Neuroscience Institute, Hamad Medical Corporation, Doha, QAT
| | - Alhady Yusof
- Critical Care, Hamad Medical Corporation, Doha, QAT
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Rahhal A, Mahfouz A, Al‐Amri M, Aljundi A, Khir F, Hamid Y, Alyafei S, Arabi AR. Impact of discharge education by clinical pharmacists on patients' adherence to post‐percutaneous coronary intervention medications: A retrospective cohort study using real‐world data. J Am Coll Clin Pharm 2021. [DOI: 10.1002/jac5.1369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Alaa Rahhal
- Pharmacy Department Heart Hospital, Hamad Medical Corporation Doha Qatar
| | - Ahmed Mahfouz
- Pharmacy Department Heart Hospital, Hamad Medical Corporation Doha Qatar
| | - Maha Al‐Amri
- Pharmacy Department Heart Hospital, Hamad Medical Corporation Doha Qatar
| | - Amer Aljundi
- Pharmacy Department Heart Hospital, Hamad Medical Corporation Doha Qatar
| | - Fadi Khir
- Internal Medicine Department Hamad General Hospital, Hamad Medical Corporation Doha Qatar
| | - Yousra Hamid
- Pharmacy Department Heart Hospital, Hamad Medical Corporation Doha Qatar
| | - Sumaya Alyafei
- Pharmacy Department Heart Hospital, Hamad Medical Corporation Doha Qatar
| | - Abdul Rahman Arabi
- Cardiology Department Heart Hospital, Hamad Medical Corporation Doha Qatar
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Rahhal A, Mahfouz A, Khir F, Okleh N, Aljundi AH, AlKhalaila O, Hamid Y, Al-Amri M, Al-Yafei SAS, Al Suwaidi J, Al-Qahtani A, Arafa S, Arabi AR. Medications adherence post-primary percutaneous coronary intervention in acute myocardial infarction: A population-based cohort study. J Clin Pharm Ther 2020; 46:772-779. [PMID: 33382471 DOI: 10.1111/jcpt.13348] [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: 11/24/2020] [Revised: 12/04/2020] [Accepted: 12/17/2020] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE The use of medications for secondary prevention is the cornerstone in the treatment of coronary artery disease (CAD). However, adherence to these medications is still suboptimal worldwide. This retrospective observational study aimed to assess the adherence to post-percutaneous coronary intervention (PCI) medications, along with predictors of non-adherence. METHODS We conducted a retrospective observational cohort study to assess the adherence to post-PCI medications by determining the rate of prescription refills for 12 months after discharge among STEMI patients, as well as predictors of non-adherence. Adherence was assessed by medication availability 80% of the time monitored by the prescription refills rate for 1 year post-discharge. RESULTS AND DISCUSSION A total of 1334 patients who presented with STEMI and underwent primary PCI were included in our retrospective analysis. The majority of patients included were male (96%) with a mean age of 51 ± 10.2 years. The overall adherence rate for all medications was only 28.4%, with an individual adherence rate of 50.5% for aspirin, 49.9% for P2 Y12 inhibitors, 48.1% for statins, 39.6% for beta-blockers and 42.9% for angiotensin-converting enzyme (ACE) inhibitors/angiotensin II receptor blockers (ARB). Factors that increased the likelihood of non-adherence were prolonged hospital length of stay and getting the medications with charge (aOR = 1.94, 95% CI 1.1-3.3; p-value = 0.017, aOR = 1.87, 95% CI 1.1-3.3; p-value = 0.029, respectively), while having a regular follow-up after discharge and attending the first clinic appointment were significantly associated with decreased likelihood of non-adherence (aOR = 0.01, 95% CI 0.004-0.04; p-value < 0.001, aOR = 0.06, 95% CI 0.03-0.1; p-value < 0.001, respectively). WHAT IS NEW AND CONCLUSION The adherence rate to post-PCI medications among patients with STEMI was relatively low; however, attending the first outpatient clinic appointment and having a regular follow-up reduced the likelihood of non-adherence.
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Affiliation(s)
- Alaa Rahhal
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Mahfouz
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Fadi Khir
- Internal Medicine Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Nawaf Okleh
- Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Osama AlKhalaila
- Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Yousra Hamid
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Maha Al-Amri
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Jassim Al Suwaidi
- Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Awad Al-Qahtani
- Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Salaheddin Arafa
- Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abdul Rahman Arabi
- Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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Rahhal A, Khir F, Aljundi AH, AlAhmad Y, Alzaeem H, Habra M, Al-Shekh I, Mahfouz A, Awaisu A, Al-Yafei S, Arabi AR. Clinical outcomes of high-intensity doses of atorvastatin in patients with acute coronary syndrome: A retrospective cohort study using real-world data. Br J Clin Pharmacol 2020; 87:2043-2052. [PMID: 33068036 DOI: 10.1111/bcp.14613] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/27/2020] [Accepted: 10/05/2020] [Indexed: 11/29/2022] Open
Abstract
AIMS To compare the effectiveness and safety of 2 high-intensity atorvastatin doses (40 mg vs 80 mg) among acute coronary syndrome (ACS) patients. METHODS This retrospective observational cohort study using real-world data included patients admitted with ACS to the Heart Hospital in Qatar between 1 January 2017 and 31 December 2018. The primary endpoint was a composite of cardiovascular disease-associated death, nonfatal ACS and nonfatal stroke. Cox proportional hazard regression analysis was used to determine the association between the 2 high-intensity atorvastatin dosing regimens and the primary outcome at 1 month and 12 months postdischarge. RESULTS Of the 626 patients included in the analyses, 475 (75.9%) received atorvastatin 40 mg, while 151 (24.1%) received atorvastatin 80 mg following ACS. Most of the patients were Asian (73%), male (97%) with a mean age of 50 years and presented with ST-elevation myocardial infarction (60%). The incidence of the primary effectiveness outcome did not differ between the atorvastatin 40-and 80-mg groups at 1 month (0.8 vs 1.3%; adjusted hazard ratio = 0.59, 95% confidence interval 0.04-8.13, P = .690) and at 12 months (3.2 vs 4%; adjusted hazard ratio = 0.57, 95% confidence interval 0.18-1.80, P = .340). Similarly, the use of the 2 doses of atorvastatin resulted in comparable safety outcomes, including liver toxicity, myopathy and rhabdomyolysis with an event rate of <1% in both groups. CONCLUSION The use of atorvastatin 40 mg in comparison to atorvastatin 80 mg in patients with ACS resulted in similar cardiovascular effectiveness and safety outcomes.
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Affiliation(s)
- Alaa Rahhal
- Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Fadi Khir
- Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Yaser AlAhmad
- Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hakam Alzaeem
- Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Masa Habra
- Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Israa Al-Shekh
- Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Mahfouz
- Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Awaisu
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
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Rahhal A, Khir F, Adam M, Aljundi A, Mohsen MK, Al-Suwaidi J. Low dose combined oral contraceptives induced thrombotic anterior wall myocardial infarction: a case report. BMC Cardiovasc Disord 2020; 20:182. [PMID: 32306901 PMCID: PMC7168836 DOI: 10.1186/s12872-020-01462-9] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/01/2020] [Indexed: 11/10/2022] Open
Abstract
Background Combined oral contraceptive pills are associated with an established risk for venous thrombosis; however, their risk for arterial thrombosis remains uncertain, especially with the development of low dose new generations of combined oral contraceptive. Arterial thrombosis is less likely to occur with the use of oral contraceptive pills in the absence of cardiovascular risk factors. Case presentation We report a 35-year old female with no cardiovascular risk factors who presented with thrombotic anterior wall myocardial infarction 6 months after using a third generation low dose combined oral contraceptive pills (Marvelon; ethinylestradiol 30 mcg and desogestrel 150 mcg). Conclusion Third generation low dose combined oral contraceptives may lead to myocardial infarction in young women, even in the absence of other cardiovascular risk factors.
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Affiliation(s)
- Alaa Rahhal
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar.
| | - Fadi Khir
- Internal Medicine Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohammad Adam
- Internal Medicine Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Amer Aljundi
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | - Mohammed Khalil Mohsen
- Cardiology and Cardiovascular Surgery Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Jassim Al-Suwaidi
- Cardiology and Cardiovascular Surgery Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
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