Dr. Kadhim Jaffer Sulaiman FRCPI, FRCP(Glasgow), FESC Senior Consultant Cardiologist &Deputy Director General (Medical)Royal Hospital Vice-President, Oman Heart Association
Background ď‚— A large number of studies have confirmed that South
Asians from Indian subcontinent, have a higher prevalence of coronary artery disease as well as a higher coronary mortality than Caucasians and Chinese.
ď‚— A significant number of people from the Indian
subcontinent reside in the Middle East. To date, there are no studies comparing ACS patients from Middle East Arab population with those from the Indian subcontinent residing in the Middle East.
Aim of the Study: ď‚— The aim of this study was to compare baseline
characteristics, clinical presentation, in-hospital outcomes and long-term mortality between Middle East Arab and Indian subcontinent patients presenting with ACS.
Methods Gulf RACE-II is a large prospective, multinational
multicenter registry of patients above 18 years of age admitted with the diagnosis of ACS.
Total of 7,930 consecutive patients were recruited from 65
hospitals in 6 adjacent Middle Eastern Arab countries (KSA, Bahrain, Qatar, UAE, Oman and Yemen), between October 2008 and June 2009.
Indian subcontinent patients included nationals from
India, Pakistan, Afghanistan, Bangladesh, Sri Lanka and Nepal, residing in those countries.
There were no exclusion criteria.
Demographic and clinical characteristics
Age, mean ± SD,years
Middle East Arab
Body mass index,
<0.001 <0.001 0.0129
Risk Factors Indian Subcontinent
Middle East Arab
<0.001 <0.001 <0.001 <0.001 <0.001
Cardiac History Indian Subcontinent
Middle East Arab
Systolic blood pressure ≤90 mmHg
Middle East Arab P-value
342 (6.0%) 0.00<1
Heart rate >100 beats/minute
1,091 (19%) <0.001
Killip class score ≥3
GRACE SCORE (%) on Presentation
In-hospital outcome/procedure (%)
Medications On discharge (%)
Impact of race on in-hospital, 1-month, and 1year mortalities of the study cohort using multiple logistic regression. Parameter
In-hospital mortality OR (95%
1-month mortality OR (95%
1-year mortality OR (95%
Middle Eastern Arab vs. Indian Subcontinent
Lost to One Year Follow-up
Lost to One year Follow-up Indian Subcontinent Middle East Arab 166 patients
Killip Class 3 & 4
Medium/ High GRACE Score
<0.001 <0.001 <0.001 <0.001 <0.001 <0.001
Conclusions ď‚— The present study is the first, to the best of our knowledge,
which compares clinical characteristics and long-term prognosis of ACS Middle East Arab patients and those from Indian subcontinent, residing in the Middle East.
ď‚— The results of this study demonstrates that Middle East Arab
patients with ACS presented a decade later, with increased prevalence of diabetes mellitus, hypertension and other risk factors when compared to patients from the Indian subcontinent.
ď‚— Middle East Arab patients presented with higher GRACE risk-
scores; were undertreated with evidence-based treatment, and had increased in-hospital complications along with a higher mortality compared to patients from the Indian subcontinent.
Conclusions ď‚— This study indicates that there is a need to aggressively
screen for the traditional risk factors and modify them in both the populations in the Middle East, including patients from Indian subcontinent who were found to have earlier onset of ACS. Furthermore, research is needed in the Middle East Arab population with regard to lipid component levels, coronary artery characteristics, gene polymorphisms and other pro-thrombotic markers.
ď‚— Further studies are needed to find out the reason behind
underuse of evidence based treatment in the Middle East patients.