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Emara AN, Wadie M, Mansour NO, Shams MEE. The clinical outcomes of dapagliflozin in patients with acute heart failure: A randomized controlled trial (DAPA-RESPONSE-AHF). Eur J Pharmacol 2023; 961:176179. [PMID: 37923161 DOI: 10.1016/j.ejphar.2023.176179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/07/2023]
Abstract
AIMS Dapagliflozin may confer additional decongestive and natriuretic benefits to patients with acute heart failure (AHF). Nonetheless, this hypothesis was not clinically examined. This study aimed primarily to investigate the effect of dapagliflozin on symptomatic relief in those patients. METHODS This was a randomized, double-blind study that included 87 patients with AHF presenting with dyspnea. Within 24 h of admission, patients were randomized to receive either dapagliflozin (10 mg/day, N = 45) or placebo (N = 42) for 30 days. The primary outcome was the difference between the two groups in the area under the curve (AUC) of visual analogue scale (VAS) dyspnea score over the first 4 days. Secondary endpoints included urinary sodium (Na) after 2 h of randomization, percent change in NT-proBNP, cumulative urine output (UOP), and differences in mortality and hospital readmission rates. RESULTS The results showed that dapagliflozin significantly reduced the AUC of VAS dyspnea score compared to placebo (3192.2 ± 1631.9 mm × h vs 4713.1 ± 1714.9 mm × h, P < 0.001). The relative change of NT-proBNP compared to its baseline was also larger with dapagliflozin (-34.89% vs -10.085%, P = 0.001). Additionally, higher cumulative UOP was found at day 4 (18600 ml in dapagliflozin vs 13700 in placebo, P = 0.031). Dapagliflozin decreased rehospitalization rates within 30 days after discharge, while it did not affect the spot urinary Na concentration, incidence of worsening of heart failure, or mortality rates. CONCLUSION Dapagliflozin may provide symptomatic relief and improve diuresis in patients with AHF. Further studies are needed to confirm these findings. https://clinicaltrials.gov/study/NCT05406505.
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Affiliation(s)
- Abdelrahman N Emara
- Clinical Pharmacy and Pharmacy Practice Department, Faculty of Pharmacy, Mansoura University, Mansoura, 35516, Egypt.
| | - Moheb Wadie
- Cardiology Department, Faculty of Medicine, Mansoura University, Mansoura, 35516, Egypt.
| | - Noha O Mansour
- Clinical Pharmacy and Pharmacy Practice Department, Faculty of Pharmacy, Mansoura University, Mansoura, 35516, Egypt; Clinical Pharmacy and Pharmacy Practice Department, Faculty of Pharmacy, Mansoura National University, Egypt.
| | - Mohamed E E Shams
- Clinical Pharmacy and Pharmacy Practice Department, Faculty of Pharmacy, Mansoura University, Mansoura, 35516, Egypt.
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Emara AN, Mansour NO, Elnaem MH, Wadie M, Dehele IS, Shams MEE. Efficacy of Nondiuretic Pharmacotherapy for Improving the Treatment of Congestion in Patients with Acute Heart Failure: A Systematic Review of Randomised Controlled Trials. J Clin Med 2022; 11:jcm11113112. [PMID: 35683505 PMCID: PMC9181246 DOI: 10.3390/jcm11113112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/22/2022] [Accepted: 05/26/2022] [Indexed: 11/16/2022] Open
Abstract
Diuretic therapy is the mainstay during episodes of acute heart failure (AHF). Diuretic resistance is often encountered and poses a substantial challenge for clinicians. There is a lack of evidence on the optimal strategies to tackle this problem. This review aimed to compare the outcomes associated with congestion management based on a strategy of pharmacological nondiuretic-based regimens. The PubMed, Cochrane Library, Scopus, and ScienceDirect databases were systematically searched for all randomised controlled trials (RCTs) of adjuvant pharmacological treatments used during hospitalisation episodes of AHF patients. Congestion relief constitutes the main target in AHF; hence, only studies with efficacy indicators related to decongestion enhancement were included. The Cochrane risk-of-bias tool was used to evaluate the methodological quality of the included RCTs. Twenty-three studies were included; dyspnea relief constituted the critical efficacy endpoint in most included studies. However, substantial variations in dyspnea measurement were found. Tolvaptan and serelaxin were found to be promising options that might improve decongestion in AHF patients. However, further high-quality RCTs using a standardised approach to diuretic management, including dosing and monitoring strategies, are crucial to provide new insights and recommendations for managing heart failure in acute settings.
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Affiliation(s)
- Abdelrahman N. Emara
- Clinical Pharmacy and Pharmacy Practice Department, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt; (A.N.E.); (N.O.M.); (M.E.E.S.)
| | - Noha O. Mansour
- Clinical Pharmacy and Pharmacy Practice Department, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt; (A.N.E.); (N.O.M.); (M.E.E.S.)
| | - Mohamed Hassan Elnaem
- Department of Pharmacy Practice, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan 25200, Pahang, Malaysia
- Quality Use of Medicines Research Group, Faculty of Pharmacy, International Islamic University Malaysia, Kuantan 25200, Pahang, Malaysia
- Correspondence:
| | - Moheb Wadie
- Cardiology Department, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt;
| | | | - Mohamed E. E. Shams
- Clinical Pharmacy and Pharmacy Practice Department, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt; (A.N.E.); (N.O.M.); (M.E.E.S.)
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Reda A, Bendary A, Elbahry A, Farag E, Mostafa T, Khamis H, Wadie M, Bendary M, Abdoul Azeem B, Salah R. Prevalence of atherosclerosis risk factors in Egyptian patients with acute coronary syndromes; final data of the nationwide cross-sectional CardioRisk project. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Little are known about the prevalence of atherosclerosis risk factors in Egyptian patients with acute coronary syndromes (ACS). Objective: To describe the prevalence of these risk factors with focus on gender-specific data and patients with premature presentation.
Methods
From November 2015 to August 2018, data were collected from 3224 patients with ACS in 30 coronary care centers covering 11 governorates across Egypt, with focus premature ACS.
Results
The vast majority were males (74%) and the most prevalent age group was (56–65 years) representing 37% of whole study population. Among female patients, 92% were post-menopausal. The prevalence of premature ACS was 51%. Forty five percent of total males and 69.6% of total females with ACS had premature presentation (P<0.001). Abdominal obesity was the most prevalent risk factor (66%). Nearly half of the entire study patients were current smokers (48%). We showed a high prevalence of documented dyslipidemia (48%) as well. Early invasive management strategy was employed in 65% of patients with no significant gender disparity noticed. Vascular access for coronary angiography was most commonly femoral (80% of time). Emergent percutaneous coronary intervention (PCI) was attempted in 53% of patients. Thrombolytic therapy (using Streptokinase) was used in 24% of included participants.
Conclusion
Among Egyptian patients with ACS, premature presentation is common with greater male preponderance. Abdominal obesity is the most prevalent risk factor followed by hypertension. Most traditional risk factors (apart from smoking) were more prevalent in women than men.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): AstraZeneca Table 1. Premature Atherosclerosis subgroupTable 2. Geographic distribution of risk factors
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Affiliation(s)
- A Reda
- Faculty of medicine Menoufia university, Cardiology, Menoufia, Egypt
| | - A Bendary
- Benha Faculty of Medicine, Cardiology, Benha, Egypt
| | - A Elbahry
- Cardiology center, Port Fouad, Egypt
| | - E Farag
- Zagazig University Hospitals, Cardiology, Zagazig, Egypt
| | - T Mostafa
- Zagazig University Hospitals, Cardiology, Zagazig, Egypt
| | - H Khamis
- 6th October University, Cardiology, Cairo, Egypt
| | - M Wadie
- Mansoura University, Cardiology, Mansoura, Egypt
| | - M Bendary
- Cairo University, National Cancer Institute, Biostatistics, Cairo, Egypt
| | | | - R Salah
- Benha Faculty of Medicine, Benha, Egypt
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Reda A, Bendary A, Elbahry A, Farag E, Mostafa T, Khamis H, Wadie M, Bendary M, Abdoul Azeem B, Salah R. Prevalence of atherosclerosis risk factors in Egyptian patients with acute coronary syndrome: final data of the nationwide cross-sectional 'CardioRisk' project. J Public Health Afr 2021; 11:1368. [PMID: 33623654 PMCID: PMC7893316 DOI: 10.4081/jphia.2020.1368] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 01/26/2021] [Indexed: 12/16/2022] Open
Abstract
Background Little are known about the prevalence of atherosclerosis risk factors in Egyptian patients with acute coronary syndromes (ACS). Objective Describe the prevalence of these risk factors with focus on gender-specific data and patients with premature presentation. Methods From November 2015 to August 2018, data were collected from 3224 patients with ACS in 30 coronary care centers covering 11 governorates across Egypt, with focus premature ACS. Results The vast majority were males (74%) and the most prevalent age group was (56-65 years) representing 37% of whole study population. Among female patients, 92% were post-menopausal. The prevalence of premature ACS was 51%. Forty five percent of total males and 69.6% of total females with ACS had premature presentation (P<0.001). Abdominal obesity was the most prevalent risk factor (66%). Nearly half of the entire study patients were current smokers (48%). We showed a high prevalence of documented dyslipidemia (48%) as well. Early invasive management strategy was employed in 65% of patients with no significant gender disparity noticed. Vascular access for coronary angiography was most commonly femoral (80% of time). Emergent percutaneous coronary intervention (PCI) was attempted in 53% of patients. Thrombolytic therapy (using Streptokinase) was used in 24% of included participants. Conclusion Among Egyptian patients with ACS, premature presentation is common with greater male preponderance. Abdominal obesity is the most prevalent risk factor followed by hypertension. Most traditional risk factors (apart from smoking) were more prevalent in women than men.
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Affiliation(s)
- Ashraf Reda
- Cardiology Department, Faculty of Medicine, Menofia University
| | - Ahmed Bendary
- Cardiology Department, Faculty of Medicine, Benha University
| | | | - Elsayed Farag
- Cardiology Department, Faculty of Medicine, Zagazig University
| | - Tamer Mostafa
- Cardiology Department, Faculty of Medicine, Zagazig University
| | - Hazem Khamis
- Cardiology Department, Faculty of Medicine, October University
| | - Moheb Wadie
- Cardiology Department, Faculty of Medicine, Mansoura University
| | - Mohamed Bendary
- Biostatistics Department, National Cancer Institute, Cairo University
| | | | - Rehab Salah
- Faculty of Medicine, Benha University, Egypt
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5
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Shaheen S, Wafa A, Mokarab M, Zareef B, Bendary A, Abdelhameed T, Rashwan A, Seleem M, Elmasry M, Abdelhady Y, Abdelrazik G, Ibrahim A, Ghareeb M, Aly K, Saraya M, Wadie M, Youssef M. Presentation, management, and outcomes of STEMI in Egypt: results from the European Society of Cardiology Registry on ST elevation myocardial infarction. Egypt Heart J 2020; 72:35. [PMID: 32607863 PMCID: PMC7326745 DOI: 10.1186/s43044-020-00069-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/10/2020] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Apart from few small single-center studies, there are limited data about STEMI patients in Egypt. Nineteen Egyptian centers (with and without PCI facilities) participated in this registry with 1356 patients who were compared to 7420 patients from other ESC countries. The aims of this study were to describe the characteristics of patients with STEMI, to assess STEMI management patterns particularly the current use of reperfusion therapies, to evaluate the organization of STEMI networks across Egypt, to evaluate in-hospital patient outcome, and to compare Egyptian patients with other ESC countries.
Results
Compared to other ESC countries, Egyptian patients were younger (mean age 55.4 ± 11.3 vs. 62.9 ± 12.4; p < 0.001 and 4.36% vs. 19.41%% were ≥ 75 years old; p < 0.001) with fewer females (18.44% vs. 25.63%; p < 0.001). Egypt had longer median time between symptoms onset and first medical contact: 120.0 (60.0; 240.0) vs.100.0 (50.0; 240.0) p < 0.001. Self-presentation rather than EMS presentation was the mode of admission in 86.06% in Egypt vs. 25.83% in EU countries (p < 0.001). On qualifying ECG, anterior STEMI was in 57.08% in Egypt vs. 45.98% in other countries (p < 0.001). Initial reperfusion therapy was 49.12%, 43.07%, and 7.26% for primary PCI, thrombolytic therapy and no reperfusion in Egypt vs. 85.42%, 7.26%, and 7.82% for EU countries, respectively. In-hospital mortality was 4.65% in Egypt vs. 3.50% in other countries p 0.040 and was 18.87% in no reperfusion vs. 2.10% in primary PCI vs. 4.97% in thrombolysis (p < 0.001) among Egyptians. Patients were discharged on aspirin in 98.61%, clopidogrel in 91.07%, ticagrelor in 7.31%, DAPT in 97.69%, beta blockers in 82.83%, ACE inhibitors in 84.76%, MRAs in 10.01%, and statins in 99.77%.
Conclusion
Compared to other ESC countries, Egyptian STEMI patients were younger, more frequently current smokers and diabetics, and had longer time between symptoms onset and first medical contact with more self-presentation rather than EMS presentation. Thrombolytic therapy is still a common reperfusion therapy in Egypt while primary PCI was offered to half of the patients. In-hospital mortality was significantly higher in Egypt and was highest among no reperfusion patients and lowest among PPCI patients.
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Wadie M, Samaan E, Nassar MK, Abdelsalam M. Estimated glomerular filtration rate as one of the main predictors of in-hospital mortality in Egyptian patients with ST elevation myocardial infarction: a two-year retrospective study. Egypt Heart J 2020; 72:32. [PMID: 32488354 PMCID: PMC7266920 DOI: 10.1186/s43044-020-00067-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 05/15/2020] [Indexed: 12/21/2022] Open
Abstract
Background Renal dysfunction is one of the major causes of in-hospital mortality in STEMI patients. In this study, we evaluated the combined predictive value of eGFR by CKD-EPI equation and shock index for in-hospital mortality and other adverse clinical outcomes in Egyptian patients with STEMI. Results A total of 450 STEMI patients were divided into 2 groups according to their eGFR with a cutoff value of 60 ml/min/1.73 m2 and compared as regards mortality, major bleeding, reinfarction, development of heart failure, stroke, and atrial fibrillation during the period of admission. Univariate analysis was performed to define significant factors that affected mortality; then, significant factors were subjected to a multivariate logistic regression. Patients with eGFR < 60 ml/min/1.73 m2 had higher rates of mortality (P < 0.0005) and atrial fibrillation (P = .006) during the hospital admission. A multivariate logistic regression model showed the predictors of mortality were factors SI (OR = 28.56, 95% CI 8–101.97, P < 0.0001), cardiac troponin (OR = 2.89, 95% CI 1.08–7.77, P = 0.03), age (OR = 1.07, 95% CI 1.02–1.2, P = 0.002), and eGFR (OR = 0.98, 95% CI 0.96–0.99, P = 0.04). Conclusions Estimated GFR < 60 ml/min/1.73 m2 in STEMI patients is associated with higher rate of mortality. Estimated GFR, age, shock index, and cardiac troponin were the most significant predictors of mortality in STEMI patients
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Affiliation(s)
- Moheb Wadie
- Department of Cardiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt.
| | - Emad Samaan
- Mansoura Nephrology and Dialysis Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohammed Kamal Nassar
- Mansoura Nephrology and Dialysis Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mostafa Abdelsalam
- Mansoura Nephrology and Dialysis Unit, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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7
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Reda A, Ashraf M, Bendary A, Elbahry A, Farag E, Bendary M, Tabl MA, Mostafa T, Wadie M, Selim M. P5487Premature coronary artery disease among Egyptian patients with acute coronary syndrome; data from the cross-sectional cardio-risk project. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Egypt is the most populous country in Middle East and North Africa and has one of the highest rates of the cardiovascular (CV) deaths in the region. Despite governmental primary preventive efforts, very little is known about the prevalence and characteristics of premature coronary artery disease (CAD) among Egyptian patients with Acute Coronary syndrome (ACS).
Methods
From November 2015 to August 2018, data were collected from 3224 patients with ACS in 30 coronary care centers covering 11 governorates across Egypt, spanning the Mediterranean coast, Nile Delta, and Upper Egypt, with focus on premature CAD (defined as ACS before age 55 years in males and 65 years in females).
Results
The prevalence of premature CAD was 51%. They were significantly more females (35% versus 16%, P<0.001) with significantly higher level of education. Risk factors' (RFs) distribution showed a significantly higher prevalence of Type-1 Diabetes Mellitus (6% versus 4%, P=0.005), obesity (42% versus 33%, P<0.001) and smoking (50% versus 47%, P<0.001) in patients with premature CAD when compared to others. Interestingly, rates of documented dyslipidemia were similar between groups (49% versus 47%, P=0.45) with no significant difference in low density lipoprotein-cholesterol levels (131.7±48.5 versus 130.2±45.2 mg/dl, P=0.4). Patients with premature CAD tended to present more frequently with ST-elevation myocardial infarction (STEMI) (50% versus 46%, P=0.035), with higher rates of treatment using primary percutaneous coronary intervention compared to others (48% versus 44%, P=0.04). They were also significantly less likely to receive Coronary Artery Bypass Graft (4% versus 6.5%, P=0.003).
Conclusion
Prevalence of premature CAD is high among Egyptian patients with ACS, due to noticeably larger burden of traditional CV RFs especially smoking and possibly familial hypercholesterolemia. Much effort is still needed in screening for early detection of RFs of atherosclerosis together with more widespread adoption of diagnostic scores for FH such as Dutch Lipid Network criteria.
Acknowledgement/Funding
AstraZeneca
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Affiliation(s)
- A Reda
- Menoufia faculty of medicine, Cardiology, Menoufia, Egypt
| | - M Ashraf
- National Heart Istitute, Giza, Egypt
| | - A Bendary
- Benha Faculty of Medicine, Cardiology, Benha, Egypt
| | - A Elbahry
- Cardiology center, Cardiology, Port Foad, Egypt
| | - E Farag
- Zagazig University Hospitals, Cardiology, Zagazig, Egypt
| | - M Bendary
- National Cancer Institute, Cairo University, Biostatistics, Giza, Egypt
| | - M A Tabl
- Benha Faculty of Medicine, Cardiology, Benha, Egypt
| | - T Mostafa
- Zagazig University Hospitals, Cardiology, Zagazig, Egypt
| | - M Wadie
- Mansoura University, Cardiology, Mansoura, Egypt
| | - M Selim
- National Heart Istitute, Giza, Egypt
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Wadie M, Alhaithami A, Wafa A, Yossof M. P843Study of the CHA2DS2-VASc score in acute coronary syndrome. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
To predict outcomes, acute coronary syndrome (ACS) can be assessed using GRACE and TIMI risk scores, whereas SYNTAX score is used to assess coronary artery disease (CAD) severity and clarify the management. CHA2DS2-VASc score is used as a predictive tool for stroke prevention in non-valvular atrial fibrillation, and it was studied in ACS in terms of outcome and CAD severity
Methods
Between December 2016 and June 2017, 125 ACS patients (mean age: 57.78 (±9.5) years, 78.4% males) were enrolled in this observational prospective study, 89 patients had been followed-up for six months. Patients were assessed based on history, clinical examination, 12-lead ECG, and coronary angiography.
Results
Subjects with a CHA2DS2-VASc score ≥2 had a higher proportion of multivessel disease (3.9%), left main coronary artery lesions (9.9%), and totally occluded, bifurcational, or long coronary lesions (60%) (All p-values<0.05). We found significant positive associations of the CHA2DS2-VASc score with the SYNTAX score (p<0.001) and the Gensini score (p<0.001). Receiver operating characteristic (ROC) curves were generated and cutoff value determined for the CHA2DS2-VASc score (cutoff>2; 76% sensitivity; 76.8% specificity; p<0.001) in predicting coronary multivessel diseases. Subjects with a CHA2DS2-VASc score ≥2 had a higher in-hospital complications, including heart failure, cardiogenic shock, renal impairment, and AF (all p-values<0.05). The CHA2DS2-VASc score showed significant positive associations with in-hospital (11.9%, p=0.21) and six-month mortality (25%, p=0.042). ROC curves were generated and cutoff value determined for the CHA2DS2-VASc score (cutoff>2; 88% sensitivity; 65.3% specificity; p<0.001) in predicting six-month-mortality. Multivariate logistic regression analysis showed that the CHA2DS2-VASc score (p<0.001 with odds ratio 2.28; 95% CI 1.47–3.53) and the GRACE score (p<0.001 with odds ratio 1.07; 95% CI 1.03–1.09) were predictors of six-month mortality.
Conclusion
CHA2DS2-VASc score is associated with increased CAD severity and in-hospital and six-month outcomes.
Acknowledgement/Funding
None
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Affiliation(s)
- M Wadie
- Mansoura Specialized Medical Hospital (MSMH), Cardiology Department, Mansoura, Egypt
| | - A Alhaithami
- Mansoura Specialized Medical Hospital (MSMH), Cardiology Department, Mansoura, Egypt
| | - A Wafa
- Mansoura Specialized Medical Hospital (MSMH), Cardiology Department, Mansoura, Egypt
| | - M Yossof
- Mansoura Specialized Medical Hospital (MSMH), Cardiology Department, Mansoura, Egypt
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Shaheen SM, Wafa A, Mokarab M, Zareef B, Bendary A, Ahmed T, Rashwan A, Selim M, Elmasry M, Abelhady Y, Abdelrazik G, Ibrahim A, Gharib M, Aly K, Wadie M. P4627Presentation, management, and outcomes of STEMI in Egypt: results from the European Society of Cardiology registry on ST elevation myocardial infarction. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Apart from few small single-center studies there are limited data about STEMI patients in Egypt.
Patients and methods
The European Society of Cardiology (ESC) Registry on ST Elevation Myocardial Infarction is a prospective, multicenter and observational registry. Nineteen Egyptian centers (with and without PCI facilities) participated in this registry with 1356 patients who were compared to 7420 patients from other ESC countries. Patient recruitment started from March 2016 to February 2018.
Aims of the study
The aims of this study was to describe the characteristics of patients with STEMI, to assess STEMI management patterns, to evaluate in-hospital patient outcome and to compare Egyptian patients with other ESC countries.
Results
Compared to other ESC countries, Egyptian patients were younger (mean age 55.4±11.3 vs. 62.9±12.4; P<0.001 and 4.3% vs. 19.4%% were ≥75 years old; P<0.001) with fewer females (18.4% vs. 25.6%; P<0.001). Fewer Egyptian patients had history of myocardial infarction (7.9% vs. 12.6%; P<0.001), chronic heart failure (2.0% vs. 11.5%; P<0.001), but Egyptians had higher prevalence of current smoking (59.0% vs. 42.8% p<0.001), Diabetes mellitus (40.7% vs. 21.9%, p<0.001). Egypt had longer median time between symptoms onset and first medical contact: 120.0 (60.0; 240.0) vs. 100.0 (50.0; 240.0) p<0.001. Self-presentation rather than EMS presentation was the mode of admission in 86.0% in Egypt vs. 25.8% in EU countries (p<0.001). On qualifying ECG, anterior STEMI was in 57.0% in Egypt vs. 45.9% in other countries (p<0.001). Initial reperfusion therapy was 49.1%, 43.0% and 7.2% for Primary PCI, thrombolytic therapy and no reperfusion in Egypt vs. 85.4%, 7.2% and 7.8% for EU countries, respectively. Thrombolysis when given was in the CCU/ICU rather than EMS or ER in 97.2% in Egypt vs. 43.7% in other countries. Compared to thrombolytic therapy, patients who were treated with primary PCI had less Cerebrovascular accident (0.75% vs. 1.3%; P<0.001), killip Class IV (3.0% vs. 5.9%; P<0.001) or AF (2.5% vs. 3.6%; P 0.008). In hospital mortality was 4.6% in Egypt vs. 3.5% in other countries P 0.040 and was 18.7% in No reperfusion vs. 2.1% in Primary PCI vs. 4.9% in Thrombolysis (P<0.001) among Egyptians. Patients were discharged on Aspirin in 98.6%, Clopidogrel in 91.0%, Ticagrelor in 7.1%, DAPT in 97.6%, Beta Blockers in 82.8%, ACE inhibitors in 84.7%, MRAs in 10.0%, and Statins in 99.7%.
Conclusion
Egyptian STEMI patients were younger, more frequently obese, smokers and diabetics had significantly longer delay between symptoms onset and first medical contact with more self-presentation rather than the recommended EMS presentation. Primary PCI was offered to only half of the patients. In hospital mortality was significantly higher and was highest among non-reperfused patients. National plans for primary and secondary prevention are urgently needed in Egypt.
Acknowledgement/Funding
This registry was funded by the ESC. The Egyptian Society of Cardiology was given a grant of €12000 to help with the implementation of this national E
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Affiliation(s)
- S M Shaheen
- Ain Shams University Hospital, Department of Cardiology, Cairo, Egypt
| | - A Wafa
- Mansoura University, Cardiology, Mansoura, Egypt
| | - M Mokarab
- Al-Azhar University, Cardiology, Cairo, Egypt
| | - B Zareef
- Enaya hospital, Cardiology, Cairo, Egypt
| | - A Bendary
- Benha Faculty of Medicine, Benha, Egypt
| | - T Ahmed
- Assiut University, Assiut, Egypt
| | - A Rashwan
- Fayoum General Hospital, Cardiology, fayoum, Egypt
| | - M Selim
- National Heart Institute, Cairo, Egypt
| | | | | | | | - A Ibrahim
- Helwan University, Cardiology, Badr, Egypt
| | - M Gharib
- Nasr City Insurance Hospital, Cardiology, Cairo, Egypt
| | - K Aly
- Ain Shams University Hospital, Department of Cardiology, Cairo, Egypt
| | - M Wadie
- Mansoura University, Cardiology, Mansoura, Egypt
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Wadie M, Shawky EM, Nassar M, Abdelsalam M. SP116ESTIMATED GLOMERULAR FILTRATION RATE AS A PREDICTOR FOR MORTALITY IN HOSPITALIZED PATIENTS WITH STEMI. Nephrol Dial Transplant 2019. [DOI: 10.1093/ndt/gfz103.sp116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Moheb Wadie
- Faculty of Medicine, Mansoura University, Egypt, Mansoura, Egypt
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Reda A, Ashraf M, Soliman M, Ragy H, El Kersh A, Abdou W, Mostafa T, Hassan M, Farag E, Khamis H, Wadie M, Elbahry A, Salama S, Kazamel G, Sadaka M, Mostafa M, Abd El-Bary A, Sanad O, Rafla S, Abd El-Hady Y, Selim M, Farag N, El-Ghawaby H, El-Araby H, Emil S, Beshay M, Shawky A, Yusef M, Abd El-Ghany M, Gamal A, Baghdady Y, Mostafa T, Zahran M, El Rabat K, Bendary A, El Shorbagy A. The pattern of risk-factor profile in Egyptian patients with acute coronary syndrome: phase II of the Egyptian cross-sectional CardioRisk project. Cardiovasc J Afr 2019; 30:87-94. [PMID: 30720847 DOI: 10.5830/cvja-2018-074] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 12/10/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Egypt is the most populous country in the Middle East and North Africa and has more than 15% of the cardiovascular deaths in the region, but little is known about the prevalence of traditional risk factors and treatment strategies in acute coronary syndrome (ACS) patients across Egypt. METHODS From November 2015 to August 2017, data were collected from 1 681 patients with ACS in 30 coronary care centres, covering 11 governorates across Egypt, spanning the Mediterranean coast, Nile Delta and Upper Egypt, with a focus on risk factors and management strategies. RESULTS Women constituted 25% of the patients. Premature ACS was common, with 43% of men aged less than 55 years, and 67% of women under 65 years. Most men had ST-elevation myocardial infarction (STEMI) (49%), while a larger percentage of women had unstable angina and non-ST-elevation myocardial infarction (NSTEMI) (32% each; p < 0.001). Central obesity was present in 80% of men and 89% of women, with 32% of men and women having atherogenic dyslipidaemia. Current smoking was reported by 62% of men and by 72% of men under 55 years. A larger proportion of women had type 2 diabetes (53 vs 34% of men), hypertension (69 vs 49%), dyslipidaemia, and obesity (71 vs 41%) (p < 0.001 for all). There were no gender differences in most diagnostic and therapeutic procedures, but among STEMI patients, 51% of men underwent primary percutaneous coronary intervention compared to 46% of women (p = 0.064). CONCLUSIONS Central obesity and smoking are extremely prevalent in Egypt, contributing to an increased burden of premature ACS, which warrants tailored prevention strategies. The recognised tendency worldwide to treat men more aggressively was less pronounced than expected.
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Affiliation(s)
- Ashraf Reda
- Department of Cardiology, Faculty of Medicine, Menofia University, Menofia, Egypt.
| | - Mohamed Ashraf
- National Heart Institute, Ministry of Health, Giza, Egypt
| | - Mahmoud Soliman
- Department of Cardiology, Faculty of Medicine, Menofia University, Menofia, Egypt
| | - Hany Ragy
- National Heart Institute, Ministry of Health, Giza, Egypt
| | - Ahmed El Kersh
- Department of Cardiology, Faculty of Medicine, Menofia University, Menofia, Egypt
| | - Waleed Abdou
- National Heart Institute, Ministry of Health, Giza, Egypt
| | - Tamer Mostafa
- Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohammed Hassan
- Department of Cardiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Elsayed Farag
- Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Hazem Khamis
- Department of Cardiology, Faculty of Medicine, October University, Cairo, Egypt
| | - Moheb Wadie
- Department of Cardiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Atef Elbahry
- Cardiology Unit, Port Foad Centre, Port Foad, Egypt
| | - Sameh Salama
- Department of Cardiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ghada Kazamel
- National Heart Institute, Ministry of Health, Giza, Egypt
| | - Mohammed Sadaka
- Department of Cardiology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Morsy Mostafa
- Department of Cardiology, Faculty of Medicine, Menofia University, Menofia, Egypt
| | - Akram Abd El-Bary
- Critical Care Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Osama Sanad
- Department of Cardiology, Faculty of Medicine, Banha University, Banha, Egypt
| | - Samir Rafla
- Department of Cardiology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Yaser Abd El-Hady
- Department of Cardiology, Faculty of Medicine, Bany Swef University, Egypt
| | - Mohammed Selim
- National Heart Institute, Ministry of Health, Giza, Egypt
| | - Nabil Farag
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Helmy El-Ghawaby
- Department of Cardiology, Faculty of Medicine, Bany Swef University, Egypt
| | - Hosam El-Araby
- Department of Cardiology, Faculty of Medicine, Assuit University, Assuit, Egypt
| | - Sameh Emil
- Cardiology Unit, Maady Military Hospital, Cairo, Egypt
| | - Morad Beshay
- Department of Cardiology, Faculty of Medicine, Menofia University, Menofia, Egypt
| | - Ahmed Shawky
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mahmoud Yusef
- Department of Cardiology, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | | | - Awni Gamal
- Department of Cardiology, Faculty of Medicine, Menofia University, Menofia, Egypt
| | - Yaser Baghdady
- Department of Cardiology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Taymour Mostafa
- Department of Cardiology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Mohammed Zahran
- Department of Cardiology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Khaled El Rabat
- Department of Cardiology, Faculty of Medicine, Banha University, Banha, Egypt
| | - Ahmed Bendary
- Department of Cardiology, Faculty of Medicine, Banha University, Banha, Egypt
| | - Amany El Shorbagy
- Department of Physiology, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
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Momtaz M, Fayed A, Wadie M, Gamal SM, Ghoniem SA, Sobhy N, Kamal Elden NM, Hamza WM. Retrospective analysis of nephritis response and renal outcome in a cohort of 928 Egyptian lupus nephritis patients: a university hospital experience. Lupus 2017; 26:1564-1570. [DOI: 10.1177/0961203317716320] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
Aim We aim to describe the pattern of response to treatment in a cohort of Egyptian lupus nephritis (LN) patients and to define variable prognostic factors. Methods We retrospectively analyzed records of 928 systemic lupus erythematosus (SLE) patients (898 females, 30 males) with biopsy-confirmed LN seen between 2006 and 2012 at Cairo University hospitals. Results Our study involved 928 SLE patients with a mean age of 26.25 ± 6.487 years, mean LN duration at time of renal biopsy 6.48 ± 4.27 months, mean SLEDAI 28.22 ± 11.7, and mean follow-up duration of 44.14 ± 17.34 months. Induction treatment achieved remission in 683 patients. Remission was achieved in all 32 patients with class II LN, compared to 651/896 (72.7%) patients in classes III, IV, and V. Induction by intravenous (IV) cyclophosphamide achieved response in 435/575 (75.7%) patients, while induction by mycophenolate mofetil (MMF) resulted in response in 216/321 (67.3%) patients ( p = 0.0068). Nephritic flares were least observed when MMF was used for maintenance (30/239 (12.6%) patients), compared to 71/365 patients (19.5%) ( p = 0.0266) when azathioprine (AZA) was used, and 22/79 patients (27.8%) ( p = 0.002) with IV cyclophosphamide. Class IV LN, high chronicity index, presence of crescents, and interstitial fibrosis in biopsies were all associated with chronic kidney disease (CKD) development eventually ( p < 0.001, p = 0.005, p = 0.012, and p = 0.031, respectively). By the end of the study duration, 305 (32.7%) patients had CKD. Logistic regression detected that high baseline serum creatinine, failure to achieve remission, hypertension, and nephritic flare were the main risk factors for poor renal outcome ( p < 0.001, p < 0.001, p = 0.004, and p < 0.001, respectively). The 5 years’ mortality was 69 (7.4%) patients with sepsis being the main cause of death. Conclusion IV cyclophosphamide superseded as induction treatment, while MMF was the best maintenance treatment. High serum creatinine, hypertension, and nephritic flare were the main risk factors for poor renal outcome.
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Affiliation(s)
- M Momtaz
- Department of Internal Medicine, Cairo University Hospital, Cairo, Egypt
| | - A Fayed
- Department of Internal Medicine, Cairo University Hospital, Cairo, Egypt
| | - M Wadie
- Department of Internal Medicine, Cairo University Hospital, Cairo, Egypt
| | - S M Gamal
- Rheumatology and Rehabilitation Department, Cairo University Hospital, Cairo, Egypt
| | - S A Ghoniem
- Rheumatology and Rehabilitation Department, Cairo University Hospital, Cairo, Egypt
| | - N Sobhy
- Rheumatology and Rehabilitation Department, Cairo University Hospital, Cairo, Egypt
| | - N M Kamal Elden
- Public Health Department, Cairo University Hospital, Cairo, Egypt
| | - W M Hamza
- Pathology Department, Cairo University Hospital, Cairo, Egypt
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