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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

Indian Subcontinent

Middle East Arab

(n=1,669; 23%)

(n=5,699; 77%)

49±9

60±13

Male gender

1,606 (96%)

3,946 (80%)

Body mass index,

990 (59%)

3,849 (61%)

>25kg/m2

P-value

<0.001 <0.001 0.0129


Risk Factors Indian Subcontinent

Middle East Arab

(n=1,669; 23%)

(n=5,699; 77%)

Diabetes mellitus

569 (34%)

2,377 (42%)

Hyperlipidemia

379 (29%)

1,998 (39%)

Hypertension

596 (36%)

2,879 (51%)

Khat chew

13 (0.8%)

1,390 (26%)

Smoker

920 (55%)

1,642 (29%)

P-value

<0.001 <0.001 <0.001 <0.001 <0.001


Cardiac History Indian Subcontinent

Middle East Arab

(n=1,669; 23%)

(n=5,699; 77%)

PCI

76 (4.6%)

576 (10.2%)

CABG

30 (1.8%)

287 (5.1%)

STEMI

1.2%

5.3%

P-value

<0.001 <0.001

<0.001


Clinical Presentation

Systolic blood pressure ≤90 mmHg

Indian Subcontinent

Middle East Arab P-value

(n=1,669; 23%)

(n=5,699; 77%)

41 (2.5%)

342 (6.0%) 0.00<1

Heart rate >100 beats/minute

253 (15%)

1,091 (19%) <0.001

Killip class score ≥3

86 (5.2%)

543 (9.5%)

STEMI

953 (57%)

2,245 (39%)

<0.001 <0.001


GRACE SCORE (%) on Presentation

P <0.001


In-hospital outcome/procedure (%)

P <0.001


Medications On discharge (%)

P <0.001


Mortality


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%

P-value

CI)

1-month mortality OR (95%

P-value

CI)

1-year mortality OR (95%

P-value

CI)

Middle Eastern Arab vs. Indian Subcontinent

1.10

0.711

1.64

0.064

1.81

0.005


Lost to One Year Follow-up


Lost to One year Follow-up Indian Subcontinent Middle East Arab 166 patients

569 patients

48

59

Diabetes mellitus

31%

42%

Hypertension

32%

54%

CHF

2%

8%

Killip Class 3 & 4

6%

9%

Medium/ High GRACE Score

7%

22%

Age

P-value

<0.001 <0.001 <0.001 <0.001 <0.001 <0.001


Conclusions ď&#x201A;&#x2014; 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&#x201A;&#x2014; 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&#x201A;&#x2014; 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&#x201A;&#x2014; 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&#x201A;&#x2014; Further studies are needed to find out the reason behind

underuse of evidence based treatment in the Middle East patients.


Thank You


SHA24/056001