The first survey of the Saudi Acute Myocardial Infarction Registry Program: Main results and long-term outcomes (STARS-1 Program).

BACKGROUND: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

The changing trends of adult Hodgkin's disease in Saudi Arabia.

OBJECTIVE: Hodgkin's disease is one of the most common malignant lymphomas affecting the younger population. This disease has diversified pathologies and clinical stages that necessitate a well optimized clinical management. Regular updating of epidemiological behavior of Hodgkin's disease is obvious from various parts of the world; however, studies from the Kingdom of Saudi Arabia (KSA) in this field are scanty and more than a decade old. The aim of this study was to investigate the current trends in presentation and distribution of Hodgkin's disease with special reference to gender, age, histopathological subtypes, and clinical stages of this disease in Saudi patients. METHODS: A total of 142 Hodgkin's disease patients attending 2 referral hospitals (King Khalid University Hospital and Security Forces Hospital) in Riyadh, KSA, were included in this study. The records from the questionnaires were analyzed retrospectively for determining the trends of Hodgkin's disease in Saudi adults, over a period of 15 years (1985-2000). RESULTS: There were 86 males and 56 females, with a male to female ratio of 1.53:1. The mean age of the patients was 28.63 years, while most of the patients were <40 years (80.3%). Nodular sclerosis was the most frequent pathology. Presence of B symptoms had a significant correlation with histology type as well as clinical stage of Hodgkin's disease. Time course analysis showed the increasing trend of Hodgkin's disease frequency, especially in younger adults. The rate of nodular sclerosis continued to increase during the entire course of study whereas the frequency of other histology types showed a decreasing trend during 1992-2000. CONCLUSION: To the author's knowledge, this is the largest case series of adult Hodgkin's disease from KSA. The results of this study revealed a different pattern of Hodgkin's disease as compared to earlier studies reported from this region. These findings provide valuable insights in the understanding of current epidemiological features of Hodgkin's disease in KSA.