The first survey of the Saudi Acute Myocardial Infarction Registry Program: Main results and long-term outcomes (STARS-1 Program)
Alhabib KF1, Kinsara AJ2, Alghamdi S3, Al-Murayeh M4, Hussein GA5, AlSaif S6, Khalaf H7,8, Alfaleh H1, Hersi A1, Kashour T1, Al-Saleh A1, Ali M9, Ullah A1, Mhish H10, Abdo AN11, Almutairi F12, Arafah MR13, AlKutshan R14, Aldosari M15, AlSabatien BY16, Alrazzaz M17, Maria AM18, Aref AH19, Selim MM20, Morsy AM21, AlTohari FA22, Alrifai AA23, Awaad AA24, El-Sayed H25, Mansour S26, Atwa AA27, Abdelkader S28, Altamimi N29, Saleh E30, Alhaidari W31, ElShihawy EHA32, Busaleh AH33, Abdalmoutaleb M34, Fawzy EM35, Mokhtar Z36, Saleh AM37, Ahmad MA38, Almasswary A39, Alshehri M4, Abohatab KM40, AlGarni T41, Butt M42, Altaj I43, Abdullah F44, Alhosni Y45, Osman HB46, Bugti N47, Aziz AA48, Alarabi A49, AlHarbi IA50.
1 Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
2 Department of Cardiology, Ministry of National Guard Health Affair, King Saud bin Abdulaziz University for Health Sciences, COM-WR King Abdullah International Medical Research Center, Jeddah, Saudi Arabia.
3 Madinah Cardiac Center, Madinah, Saudi Arabia.
4 Armed Forces Hospitals Southern Region, Khamis Mushayt, Saudi Arabia.
5 King Salman (North West Armed Forces Hospital), Tabuk, Saudi Arabia.
6 Saud AlBabtain Cardiac Center, Dammam, Saudi Arabia.
7 Prince Sultan Cardiac Center, Buraydah City, Saudi Arabia.
8 Ha’il Cardiac Center, Hail, Saudi Arabia.
9 Saudi Heart Association, Riyadh, Saudi Arabia.
10 King Salman Heart Center, King Fahd Medical City, Riyadh, Saudi Arabia.
11 Obeid Specialized Hospital, Riyadh, Saudi Arabia.
12 Security Forces Hospital, Riyadh, Saudi Arabia.
13 Dallah Hospital, Riyadh, Saudi Arabia.
14 Aljazeera Hospital, Riyadh, Saudi Arabia.
15 King Saud Medical City (Riyadh Medical Complex), Riyadh, Saudi Arabia.
16 Alwatani /National Care Hospital, Riyadh, Saudi Arabia.
17 AlFalah Hospital, Riyadh, Saudi Arabia.
18 King Salman Hospital, Riyadh, Saudi Arabia.
19 Imam Abdulrahman Al Faisal Hospital, Riyadh, Saudi Arabia.
20 King Fahad General Hospital-Jeddah, Saudi Arabia.
21 AlNoor Specialist Hospital, Makkah, Saudi Arabia.
22 Security Forces Hospital, Makkah, Saudi Arabia.
23 King Abdulaziz Hospital and Oncology Center, Jeddah, Saudi Arabia.
24 Althager General Hospital, Jeddah, Saudi Arabia.
25 King Abdulaziz Specialist Hospital, AlTaif, Saudi Arabia.
26 AlZahra Hospital, Madinah, Saudi Arabia.
27 Al-Dar Hospital, Madinah, Saudi Arabia.
28 AlMiqat Hospital, Madinah, Saudi Arabia.
29 King Fahad Hospital, Madinah, Saudi Arabia.
30 Ohud Hospital, Madinah, Saudi Arabia.
31 Alansar Hospital, Madinah, Saudi Arabia.
32 Prince Sultan Cardiac Center, AlHofuf /AlHasa, Saudi Arabia.
33 Al Qateef Central Hospital, Al Qateef, Saudi Arabia.
34 Mohammad Dossary Hospital, Alkhobar, Saudi Arabia.
35 King Khalid General Hospital, Hafar Albatin, Saudi Arabia.
36 King Saud Hospital, Unizah, Saudi Arabia.
37 Dr.Sulaiman Alhabib Hospital, Buraydah, Saudi Arabia.
38 Alrass General Hospital, Arrass, Saudi Arabia.
39 Aseer Central Hospital, Abha, Saudi Arabia.
40 AlNamas General Hospital, AlNamas, Saudi Arabia.
41 Khamis Mushayt General Hospital, Khamis Mushayt, Saudi Arabia.
42 King Khalid Civilian Hospital, Tabuk, Saudi Arabia.
43 Arar Cardiac Center (Prince Abdulla bin Abdulaziz bin Musaed Cardiac Center), Arar, Saudi Arabia.
44 Prince Abdulaziz Bin Musaid Hospital, Arar, Saudi Arabia.
45 Prince Sultan Cardiac Center-King Khalid Hospital, Najran, Saudi Arabia.
46 Prince Meteb Ibn Abdulaziz Hospital, Sakaka, Saudi Arabia.
47 King Abdullaziz Specialist Hospital, Sakaka, Saudi Arabia.
48 Dumat AlJandal Hospital, Dumat AlJandal, Saudi Arabia.
49 King Fahd Hospital, AlBaha, Saudi Arabia.
50 King Fahad Central Hospital, Jizan, Saudi Arabia.
Year of Publication:
Prior acute coronary syndrome (ACS) registries in Saudi Arabia might not have accurately described the true demographics and cardiac care of patients with ACS. We aimed to evaluate the clinical characteristics, management, and outcomes of a representative sample of patients with acute myocardial infarction (AMI) in Saudi Arabia.
We conducted a 1-month snap-shot, prospective, multi-center registry study in 50 hospitals from various health care sectors in Saudi Arabia. We followed patients for 1 month and 1 year after hospital discharge. Patients with AMI included those with or without ST-segment elevation (STEMI or NSTEMI, respectively). This program survey will be repeated every 5 years.
Between May 2015 and January 2017, we enrolled 2233 patients with ACS (mean age was 56 [standard deviation = 13] years; 55.6% were Saudi citizens, 85.7% were men, and 65.9% had STEMI). Coronary artery disease risk factors were high; 52.7% had diabetes mellitus and 51.2% had hypertension. Emergency Medical Services (EMS) was utilized in only 5.2% of cases. Revascularization for patients with STEMI included thrombolytic therapy (29%), primary percutaneous coronary intervention (PCI); (42.5%), neither (29%), or a pharmaco-invasive approach (3%). Non-Saudis with STEMI were less likely to undergo primary PCI compared to Saudis (35.8% vs. 48.7%; respectively, p <0.001), and women were less likely than men to achieve a door-to-balloon time of <90 min (42% vs. 65%; respectively, p = 0.003). Around half of the patients with NSTEMI did not undergo a coronary angiogram. All-cause mortality rates were 4%, 5.8%, and 8.1%, in-hospital, at 1 month, and at 1 year, respectively. These rates were significantly higher in women than in men.
There is an urgent need for primary prevention programs, improving the EMS infrastructure and utilization, and establishing organized ACS network programs. AMI care needs further improvement, particularly for women and non-Saudis.