International Journal of Clinical Pharmacy

, Volume 34, Issue 3, pp 445–451 | Cite as

Primary coronary intervention versus thrombolytic therapy in myocardial infarction patients in the Middle East

  • Ibrahim Al-ZakwaniEmail author
  • Mohammad Zubaid
  • Adil Al-Riyami
  • Muath Alanbaei
  • Kadhim Sulaiman
  • Wael Almahmeed
  • Ahmed Al-Motarreb
  • Jassim Al Suwaidi
Research Article


Background Little is known about predictors and outcome differences of primary percutaneous coronary intervention (PPCI) and thrombolytic therapy (TT) in ST-segment elevation myocardial infarction (STEMI) patients in the Middle East. Objective To compare predictors as well as in-hospital outcomes of PPCI and TT in STEMI patients in six Middle Eastern countries. Setting Sixty-five hospitals (covering at least 85 % of the population) in Oman, United Arab Emirates, Qatar, Bahrain, Kuwait and Yemen. Methods This was a prospective, multinational, multicentre, observational survey of consecutive acute coronary syndrome patients who were admitted to 65 hospitals during May 8, 2006 to June 6, 2006 and from January 29, 2007 to June 29, 2007, as part of Gulf RACE (Registry of Acute Coronary Events). Analyses were performed using univariate and multivariate statistical techniques. Main outcome measures Predictors as well as in-hospital outcomes of PPCI and TT in STEMI patients. Results Out of 2,155 STEMI patients admitted to hospitals within 12 h of symptoms onset, 92 % received reperfusion (8 % PPCI and 84 % TT). TT use included reteplase (43 %), tenecteplase (30 %), streptokinase (25 %), and alteplase (2 %). Median age of the study cohort was 50 (44–58) years with majority being males (90 %). There were no significant differences in median onset time to presentation between the TT and PPCI groups (130 vs. 120 min; P = 0.422). Median door-to-needle time and door-to-balloon time were 45 min (29–75) and 75 min (58–120), respectively. Predictors of PPCI included prior PCI, hospitals with catheterization laboratory facilities as well as those involved with academia. Multivariate logistic regression model demonstrated that patients that had PPCI were less likely to have recurrent ischemic attacks than those that had TT (odds ratio, 0.18; 95 % CI, 0.06–0.56; P = 0.003). Conclusions The main reperfusion strategy for STEMI patients in the Arab Middle East region is thrombolytic therapy. Predictors of primary percutaneous coronary intervention included prior percutaneous coronary intervention, hospitals with catheterization laboratory facilities as well as those involved with academia. Primary percutaneous coronary intervention resulted in significant reductions in recurrent ischemic events when compared to thrombolytic therapy.


Arab Countries Ischemic attack Myocardial infarction Primary angioplasty Thrombolysis 



The authors would like to thank the patients, physicians, nurses, and support staff participating in the Gulf RACE registry for their invaluable cooperation.


We disclose the receipt of a grant for this Gulf RACE project from Gulf Heart Association with finances supported by Sanofi Aventis and Qatar Telecommunications Company.

Conflicts of interest

The authors declare no conflicts of interest with respect to the authorship and/or publication of this article.


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Copyright information

© Springer Science+Business Media B.V. 2012

Authors and Affiliations

  • Ibrahim Al-Zakwani
    • 1
    • 2
    Email author
  • Mohammad Zubaid
    • 3
  • Adil Al-Riyami
    • 4
  • Muath Alanbaei
    • 3
  • Kadhim Sulaiman
    • 5
  • Wael Almahmeed
    • 6
  • Ahmed Al-Motarreb
    • 7
  • Jassim Al Suwaidi
    • 8
  1. 1.Department of Pharmacology and Clinical PharmacyCollege of Medicine and Health Sciences, Sultan Qaboos UniversityAl-Khodh, MuscatSultanate of Oman
  2. 2.Gulf Health ResearchMuscatOman
  3. 3.Department of MedicineKuwait UniversityKuwait CityKuwait
  4. 4.Department of MedicineSultan Qaboos University HospitalMuscatOman
  5. 5.Department of CardiologyRoyal HospitalMuscatOman
  6. 6.Division of CardiologySheikh Khalifa Medical CityAbu DhabiUnited Arab Emirates
  7. 7.Department of Medicine, Faculty of MedicineSana’a UniversitySanaaYemen
  8. 8.Division of CardiologyHamad Medical CorporationDohaQatar

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