Acute Coronary Syndromes (STEMI, NSTE-ACS)
Acute Myocardial Infarction Cardiogenic Shock (AMICS) in Middle Eastern Patients, Insights From a 23-Years Registry
Ghiath Sadek Baroudy1, Mohamed Salah Abdelghani2, Abdul Rahman Arabi2, Rajvir Singh2, Jassim Al Suwaidi2, Awad Alqahtani2, Hajar Albinali2
Hamad Medical Corporation Heart Hospital, Qatar1, HMC Heart Hospital, Qatar2
Limited information regarding the clinical characteristics and outcome of AMICS in Middle Eastern patients.Objectives:
To compare the clinical profile, management and outcomes of patients with AMICS vs, acute myocardial Infarction without cardiogenic shock.
Retrospective analysis of the 23-year registry data (Jan 1991 to May 2013) of cardiac patients hospitalized at Hamad General Hospital and Heart Hospital, Doha, Qatar.
A total of 16,070 consecutive patients were admitted with Acute MI during the study period, of whom 1481 (9.2%) had a diagnosis of AMICS. The incidence had increased from 7% in the first quarter of the study to 11% in the last quarter (P=0.01). Compared to acute MI without cardiogenic shock, AMICS patients were older (59.1±12.6 vs. 53.1±11.7, P=0.001) more likely to have diabetes (57% vs. 39%, P=0.001), hypertension (55% vs. 37%, P=0.001), dyslipidemia (12% vs. 9%, P=0.005), chronic kidney disease (11% vs. 3%, P=0.001) and history of prior MI (22% vs. 11%, P=0.001), but they are less likely to be males (75% vs. 89%, P=0.001) or to be smokers (25% vs. 37P=0.001).AMICS patients had significantly higher in-hospital mortality rate (43.5% versus 2.5 %, P= value 0.001).The mortality rate declined from 74% in the first quarter to less than 20% in the last quarter.
The incidence of AMICS is increasing, Patients with AMICS are older and more likely to have traditional risk factors other than smoking, Despite the significant improvement in survival, the mortality rate is still very high.