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Background: Myocardial infarction with non-obstructive coronary artery (MINOCA) is a syndrome, which requires both clinical documentation of ST-elevation myocardial infarction (STEMI) (abnormal cardiac biomarker, ischemic symptoms, and electrocardiography changes) and detection of nonobstructive coronary arteries. The purpose of this study is to determine the incidence of and characteristics of patients with MINOCA in the Yemeni population. Methods: Consecutive patients admitted between January and June 2019 at Al-Thawra Hospital, Sana'a (Yemen), with STEMI diagnosis were enrolled in this study. Demographic, clinical, echocardiographic, and coronary angiography characteristics of patients were noted. Results: MINOCA was identified in 63 patients (25%) out of 249 admitted with STEMI diagnosis at Al-Thawra Hospital. The mean age of MINOCA patients was similar to obstructive coronary group; however, they were more often females and less frequently with diabetes and family history of coronary artery disease. Other risk factors like smoking, arterial hypertension, dyslipidemia, and oral tobacco were similar. Conversely, the percentage of Khat chewers was significantly higher in the MINOCA patients (P < 0.01) as compared to obstructive group. Conclusions: The relatively high incidence of MINOCA in our country and the long list of multiple potential causes of MINOCA should open further working diagnosis after coronary angiography and further efforts for defining the cause of myocardial infarction in each individual patient in Middle East countries.
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AIMS: There is a shortage of data about acute heart failure (AHF) in the young, including its underlying causes, clinical presentation and outcomes. We aim to describe clinical characteristics, causes and outcomes of AHF in Yemeni patients aged 50years or younger. METHODS AND RESULTS: we evaluated Yemeni patients with AHF enrolled in Gulf CARE registry. Patients were divided into two groups: young patients (≤50years) and older patients (>50years). A total of 1536 patients with AHF were enrolled, of whom 635 (41.3%) were 50years old or younger. The mean age for this group was 38.8 (±9.5) years; and 399 (62.8%) were males. Younger patients had a higher prevalence of non-ischemic cardiomyopathy (41% vs 11.1%, p<0.001), primary valvular disease (27.9% vs 3.2%, p<0.001), viral myocarditis (0.8% vs 0, p<0.001). Ischemic heart disease (61.6% vs 25.5%, p<0.001) and hypertensive heart disease (18.3% vs 6.3%, p<0.001) were more frequent in the elderly group. Cardiogenic shock was more frequent among younger patients (13.7% vs 7.0, p<0.001). In-hospital mortality was higher in patient aged ≤50years (12% vs 7.6%, p=0.002) while no difference in all-cause mortality was present at 3months (17.8 vs 14.5, p=0.089) and after 1year (21.9% vs 20.6%, p=0.56). CONCLUSION: This analysis of Gulf CARE registry represents the largest report of patients admitted with AHF in Yemen. There were differences among cause of HF and precipitating factors of AHF among younger and elderly patients. Younger patients had higher in-hospital mortality and more severe clinical condition at admission.