Abstract 12773: Ethnicity and Primary PCI for ST-Elevation Myocardial Infarction: Data From the First "Nationwide" Primary PCI Program
Introduction: The Middle East is posed to witness one of the highest rise in Coronary Artery Disease (CAD) in the world and at younger age. Multi-Ethnic society is a prominent feature in the Gulf. A nationwide 24/7 Primary PCI (PPCI) program was established for all for STEMI patients. This analysis compares the two most dominant ethnic groups in the gulf, namely Arabs and Asians.
Methods: Primary PCI was performed in 496 patients with STEMI, 121 Arabs and 375 Asians. Asians were 6 years younger (48±8 vs 54±12 year, p<0.001), and had fewer females (2.6% vs 11%). Conversely, Arabs had more frequent Diabetes (42% vs 32% in Asians) and Smoking (37% vs 30% respectively). However, in-hospital mortality was similar (1.1 vs 1%).
Results: The Door to Balloon Time (DBT) was similar, Asians (55.5 ±19) vs Arabs (56±25 min), p<0.13) and 93% achieved DBT<90min in both groups. Ejection fraction (EF) was also similar (44±8% vs 45.5%), but Asians with DBT>90min had lower EF (42%) than Arab counterparts (48%). This may indicate greater myocardial vulnerability with delay in Asians. Further total coronary Occlusion (TIMI-0) at presentation was seen more frequently in Asians (60%) than in Arabs (48%), p<0.01, but TIMI-III from TIMI-0 was achieved in similar proportion (85% vs 87%). However, in the range of TIMI flow (0-II), TIMI-III was achieved in fewer Asians (94%) compared to Arabs (97%). First ECG on arrival was normal in 5.6% Asians and 2.7% Arabs, however, TIMI-0 flow was found in 60% and 44% respectively. There was a trend towards longer Out of Hospital Delay (OHD, i.e. time from symptoms to arrival to hospital) in Asians (265min) vs 234min in Arabs, particularly in Asian females (409min) vs 330min in Arab females. Radial access was used similarly in Asians vs Arabs (48% vs 45%), and a fall of ≥2gr of Hemoglobin (13% in both). Length of stay was similar (2.7 vs 2.6 days respectively).
Conclusion: The age of our STEMI patients is one of the youngest worldwide. It is even younger in Asians than Arabs. Despite greater risk profile and relatively older age in Arabs, in-hospital mortality in Primary PCI was similar. There was similar and excellent DBT in both, but Out of Hospital Delay was greater in Asians, especially females. Time delay appear to have greater adverse effect on the Ejection Fraction in Asians.
Author Disclosures: A. Gehani: None. J. Al Suwaidi: None. O. Tamimi: None. S. Arafa: None. A. Al Quhtani: None. A. Arabi: None. I. Rafie: None. A. Nabti: None. S. Abujalala: None. R. Elsousy: None. M. Yacoub: None.
- © 2014 by American Heart Association, Inc.