Acute Triple Coronary Artery Occlusion Leading to Cardiogenic Shock and Cardiac Arrest Emphasizing the Role of Mechanical Circulatory Support (Escalate before It's Too Late).

We report a case of cardiac arrest in a 38-year-old male with no past medical history who presented as a case of ST-segment elevation myocardial infarction, and coronary angiography showed triple coronary artery thrombosis complicated with cardiogenic shock (CS) that warrants starting on inotropic support and insertion of intra-aortic balloon pump. CS diagnosis with a high likelihood of deterioration was established based on hemodynamics assessment; hence, an early prompt decision for escalation of mechanical circulatory support to Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was made, which helped to prevent the patient's further deterioration and organ damage. The patient had uneventful VA-ECMO decannulation and was transferred to the ward and discharged after 28 days in stable condition on oral medical therapy and was following up regularly in the cardiology clinic. Therefore, early hemodynamics assessment in acute myocardial infarction CS cases will help predict rapid worsening, which may require prompt escalation of mechanical circulatory support and perhaps improve the outcome.

Genetic Susceptibility to Arrhythmia Phenotypes in a Middle Eastern Cohort of 14,259 Whole-Genome Sequenced Individuals.

Background: The current study explores the genetic underpinnings of cardiac arrhythmia phenotypes within Middle Eastern populations, which are under-represented in genomic medicine research. Methods: Whole-genome sequencing data from 14,259 individuals from the Qatar Biobank were used and contained 47.8% of Arab ancestry, 18.4% of South Asian ancestry, and 4.6% of African ancestry. The frequency of rare functional variants within a set of 410 candidate genes for cardiac arrhythmias was assessed. Polygenic risk score (PRS) performance for atrial fibrillation (AF) prediction was evaluated. Results: This study identified 1196 rare functional variants, including 162 previously linked to arrhythmia phenotypes, with varying frequencies across Arab, South Asian, and African ancestries. Of these, 137 variants met the pathogenic or likely pathogenic (P/LP) criteria according to ACMG guidelines. Of these, 91 were in ACMG actionable genes and were present in 1030 individuals (~7%). Ten P/LP variants showed significant associations with atrial fibrillation p < 2.4 × 10-10. Five out of ten existing PRSs were significantly associated with AF (e.g., PGS000727, p = 0.03, OR = 1.43 [1.03, 1.97]). Conclusions: Our study is the largest to study the genetic predisposition to arrhythmia phenotypes in the Middle East using whole-genome sequence data. It underscores the importance of including diverse populations in genomic investigations to elucidate the genetic landscape of cardiac arrhythmias and mitigate health disparities in genomic medicine.

Correlations between Resting Electrocardiogram Findings and Disease Profiles: Insights from the Qatar Biobank Cohort.

BACKGROUND: Resting electrocardiogram (ECG) is a valuable non-invasive diagnostic tool used in clinical medicine to assess the electrical activity of the heart while the patient is resting. Abnormalities in ECG may be associated with clinical biomarkers and can predict early stages of diseases. In this study, we evaluated the association between ECG traits, clinical biomarkers, and diseases and developed risk scores to predict the risk of developing coronary artery disease (CAD) in the Qatar Biobank. METHODS: This study used 12-lead ECG data from 13,827 participants. The ECG traits used for association analysis were RR, PR, QRS, QTc, PW, and JT. Association analysis using regression models was conducted between ECG variables and serum electrolytes, sugars, lipids, blood pressure (BP), blood and inflammatory biomarkers, and diseases (e.g., type 2 diabetes, CAD, and stroke). ECG-based and clinical risk scores were developed, and their performance was assessed to predict CAD. Classical regression and machine-learning models were used for risk score development. RESULTS: Significant associations were observed with ECG traits. RR showed the largest number of associations: e.g., positive associations with bicarbonate, chloride, HDL-C, and monocytes, and negative associations with glucose, insulin, neutrophil, calcium, and risk of T2D. QRS was positively associated with phosphorus, bicarbonate, and risk of CAD. Elevated QTc was observed in CAD patients, whereas decreased QTc was correlated with decreased levels of calcium and potassium. Risk scores developed using regression models were outperformed by machine-learning models. The area under the receiver operating curve reached 0.84 using a machine-learning model that contains ECG traits, sugars, lipids, serum electrolytes, and cardiovascular disease risk factors. The odds ratio for the top decile of CAD risk score compared to the remaining deciles was 13.99. CONCLUSIONS: ECG abnormalities were associated with serum electrolytes, sugars, lipids, and blood and inflammatory biomarkers. These abnormalities were also observed in T2D and CAD patients. Risk scores showed great predictive performance in predicting CAD.

The Effect of Beta-Blocker Post-Myocardial Infarction With Ejection Fraction >40% Pooled Analysis From Seven Arabian Gulf Acute Coronary Syndrome Registries.

The use of beta-blockers (BB) in reduced left ventricular ejection fraction (LVEF) post-myocardial infarction (MI) is associated with reduced 1-year mortality, while their role in patients with mid-range and preserved LVEF post-MI remains controversial. We studied 31,620 patients who presented with acute coronary syndrome (ACS) enrolled in seven Arabian Gulf registries between 2005 and 2017. Patients with LVEF ≤40% were excluded. The remaining cohort was divided into two groups: BB group (n = 15,541) and non-BB group (n = 2,798), based on discharge medications. Patients in the non-BB group were relatively younger (55.3 vs. 57.4, P = .004) but higher risk at presentation; with higher Global Registry of Acute Coronary Events (GRACE) score (119.2 vs 109.2, P < .001), higher percentage of cardiogenic shock (3.5 vs 1.4%, P < .001), despite lower prevalence of comorbidities, such as hypertension and hyperlipidemia. BB use was associated with lower 1-year mortality in a multivariate logistic regression analysis, adjusting for major confounders [adjusted odds ratio (OR): 0.71 (95% CI 0.51-0.99)]. This remained the case in a sensitivity analysis using propensity score matching [adjusted OR: 0.34 (95% CI 0.16-0.73)]. In this study, using Arabian Gulf countries registries, the use of BB after ACS with LVEF >40% was independently associated with lower 1-year mortality.

Morbidity and mortality of acute heart failure patients stratified by mitral regurgitation in the Arabian Gulf: Observations from the Gulf acute heart failure registry (Gulf CARE).

This study aimed to evaluate the clinical outcomes of patients with acute heart failure (AHF) stratified by mitral regurgitation (MR) in the Arabian Gulf. Patients from the Gulf CARE registry were identified from 47 hospitals in seven Arabian Gulf countries (Yemen, Oman, Kuwait, Qatar, Bahrain, the United Arab Emirates, and Saudi Arabia) from February to November 2012. The cohort was stratified into two groups based on the presence of MR. Univariable and multivariable statistical analyses were performed. The population cohort included 5005 consecutive patients presenting with AHF, of whom 1491 (29.8 %) had concomitant MR. The mean age of patients with AHF and concomitant MR was 59.2 ± 14.9 years, and 63.1 % (n = 2886) were male. A total of 58.6 % (n = 2683) had heart failure (HF) with reduced ejection fraction (EF) (HFrEF), 21.0 % (n = 961) had HF with mildly reduced EF (HFmrEF), and 20.4 % (n = 932) had HF with preserved EF (HFpEF). Patients with MR had a lower haemoglobin (Hb) level (12.4 vs. 12.7 g/dL; p < 0.001), and a higher prevalence of left atrial enlargement (80.2 % vs. 55.1 %; p < 0.001), cardiogenic shock (9.7 % vs. 7.3 %; p = 0.006) and atrial fibrillation (7.6 % vs. 5.6 %; p = 0.006), and HFrEF (71.0 % vs. 52.6 %; P < 0.001). Multivariable analysis demonstrated that MR was independently associated with increased all-cause mortality at 1-year and 3-month HF rehospitalization [1-year all-cause mortality, adjusted odds ratio (aOR), 1.40; 95 % confidence interval (Cl): 1.13-1.74; p = 0.002; 3-month HF rehospitalization, aOR, 1.26; 95 % Cl: 1.06-1.49; p = 0.009]. In an Arabian Gulf cohort with AHF, concomitant MR was associated with an increased risk of 1-year mortality and 3-months HF rehospitalization.

Patterns and Outcomes of Obesity Using Body Mass Index in Patients Hospitalized with Acute Cardiovascular Disorders: A Retrospective Analysis of 7284 Patients in a Middle Eastern Country.

BACKGROUND: We aimed to study the presentation and in-hospital outcomes of obese patients hospitalized for cardiovascular diseases (CVDs) in a Middle Eastern country. METHODS: This retrospective study included patients admitted to the Heart Hospital between 2015 and 2020. Patients were divided according to their body mass index (BMI): Group I (BMI 18.5-24.9), Group II (BMI 25-29.9), and Group III (BMI ≥ 30), by applying one-way ANOVAs and chi-square tests. The obese group (BMI ≥ 30) was graded and compared (Grade I (BMI 30-34.9), Grade II (BMI 35-39.9), and Grade III (BMI ≥ 40)). RESULTS: There were 7284 patients admitted with CVDs (Group I (29%), Group II (37%), and Group III (34%)). The mean age was higher in Group III than Groups I and II (p < 0.001). Male sex was predominant in all groups except for morbid obesity (Grade III), in which females predominated. Diabetes mellitus (DM), hypertension, and dyslipidemia were more common in Group III. Chest pain was more common in Group II, while shortness of breath was more evident in Group III (p < 0.001). Group II had more ST-elevation myocardial infarction (STEMI), followed by Group I (p < 0.001). Atrial fibrillation (AF) was observed more frequently in Group III (p < 0.001). Congestive heart failure (CHF) was common in Group III (19%) (p < 0.001). In the subanalysis, (Grade I (62%), Grade II (22.5%), and Grade III (15.5%)), Grade I had more STEMI, whereas AF and CHF were higher in Grade III (p < 0.001). Percutaneous Coronary Intervention was performed less frequently in Grade III (p < 0.001). In-hospital mortality was higher in Grade III (17.1%), followed by Grades II (11.2%) and I (9.3%) (p < 0.001). CONCLUSIONS: In this study, one third of the hospitalized CVS patients were obese. AF and CHF with preserved EF were the most common cardiovascular presentations in obese patients. In patients with CVDs, obesity was associated with higher rates of comorbidities and in-hospital mortality. However, obesity measured by BMI alone was not an independent predictor of mortality in obese cardiac patients.

Overweight and obesity are associated with better survival in STEMI patients with diabetes.

OBJECTIVE: The relationship between obesity and in-hospital outcomes in individuals with type 2 diabetes mellitus (T2DM) who develop an ST-elevation myocardial infarction (STEMI) was assessed. METHODS: Data from the National Inpatient Sample (NIS) from 2008 to 2017 were analyzed. Patients with STEMI and T2DM were classified as being underweight or having normal weight, overweight, obesity, and severe obesity. The temporal trend of those BMI ranges and in-hospital outcomes among different obesity groups were assessed. RESULTS: A total of 74,099 patients with T2DM and STEMI were included in this analysis. In 2008, 35.8% of patients had obesity, and 37.3% had severe obesity. However, patients with obesity accounted for most of the study population in 2017 (57.8%). During the observation period, mortality decreased in underweight patients from 18.1% to 13.2% (p < 0.001). Still, it gradually increased in all other BMI ranges, along with cardiogenic shock, atrial fibrillation, and ventricular fibrillation (p < 0.001 for all). After the combination of all patients during the observation period, mortality was lower in patients with overweight and obesity (adjusted odds ratio = 0.625 [95% CI 0.499-0.784]; 0.606 [95% CI 0.502-0.733], respectively). CONCLUSIONS: A U-shaped association governs the relationship between BMI and mortality in STEMI patients with diabetes, with those having overweight and obesity experiencing better survival.

Predictors of 30-Day Re-admission in Cardiac Patients at Heart Hospital, Qatar.

Background: Cardiovascular disease patients are more likely to be readmitted within 30 days of being discharged alive. This causes an enormous burden on health-care systems in terms of poor care of patients and misutilization of resources. Aims and Objective: This study aims to find out the risk factors associated with 30-day readmission in cardiac patients at Heart Hospital, Qatar. Methods: A total of 10,550 cardiac patients who were discharged alive within 30 days at the heart hospital in Doha, Qatar, from January 2015 and December 2019 were analyzed. The bootstrap method, an internal validation statistical technique, was applied to present representative estimates for the population. Results: Out of the 10,550 cardiac patients, there were 8418 (79.8%) index admissions and 2132 (20.2%) re-admitted at least once within 30 days after the index admission. The re-admissions group was older than the index admission group (65.6 ± 13.2 vs. 56.0 ± 13.5, P = 0.001). Multinomial regression analysis showed that females were 30% more likely to be re-admitted than males (adjusted odds ratio [aOR] 1.30, 95% confidence interval [CI]: 1.11-1.50, P = 0.001). Diabetes (aOR 1.36, 95% CI: 1.20-1.53, P = 0.001), chronic renal failure (aOR 1.93, 95% CI: 1.66-2.24, P = 0.001), previous MI (aOR 3.22, 95% CI: 2.85-3.64, P = 0.001), atrial fibrillation (aOR 2.17, 95% C.I. : 1.10-2.67, P = 0.01), cardiomyopathy (aOR 1.72, 95% CI 1.47-2.02, P = 0.001), and chronic heart failure (aOR 1.56, 95% C.I.: 1.33-1.82, P = 0.001) were also independent predictors for re-admission in the regression model. C-statistics showed these variables could predict 82% accurately hospital readmissions within 30 days after being discharged alive. Conclusion: The model was more than 80% accurate in predicting 30-day readmission after being discharged alive. The presence of five or more risk factors was found to be crucial for readmissions within 30 days. The study may help design interventions that may result in better outcomes with fewer resources in the population.

Type 2 diabetes and in-hospital sudden cardiac arrest in ST-elevation myocardial infarction in the US.

Aims: We aimed to assess the impact of diabetes on sudden cardiac arrest (SCA) in US patients hospitalized for ST-elevation myocardial infarction (STEMI). Methods: We used the National Inpatient Sample (2005-2017) data to identify adult patients with STEMI. The primary outcome was in-hospital SCA. Secondary outcomes included in-hospital mortality, ventricular tachycardia (VT), ventricular fibrillation (VF), cardiogenic shock (CS), acute renal failure (ARF), and the revascularization strategy in SCA patients. Results: SCA significantly increased from 4% in 2005 to 7.6% in 2018 in diabetes patients and from 3% in 2005 to 4.6% in 2018 in non-diabetes ones (p < 0.001 for both). Further, diabetes was associated with an increased risk of SCA [aOR = 1.432 (1.336-1.707)]. In SCA patients with diabetes, the mean age (SD) decreased from 68 (13) to 66 (11) years old, and mortality decreased from 65.7% to 49.3% during the observation period (p < 0.001). Compared to non-diabetes patients, those with T2DM had a higher adjusted risk of mortality, ARF, and CS [aOR = 1.72 (1.62-1.83), 1.52 (1.43-1.63), 1.25 (1.17-1.33); respectively] but not VF or VT. Those patients were more likely to undergo revascularization with CABG [aOR = 1.197 (1.065-1.345)] but less likely to undergo PCI [aOR = 0.708 (0.664-0.754)]. Conclusion: Diabetes is associated with an increased risk of sudden cardiac arrest in ST-elevation myocardial infarction. It is also associated with a higher mortality risk in SCA patients. However, the recent temporal mortality trend in SCA patients shows a steady decline, irrespective of diabetes.

Primary hyperaldosteronism is associated with increased mortality and morbidity in patients with hypertension and diabetes.

Aims: Primary hyperaldosteronism (PA) is a common cause of hypertension. It is more prevalent in patients with diabetes. We assessed the cardiovascular impact of PA in patients with established hypertension and diabetes. Methods: Data from the National Inpatient Sample (2008-2016) was used to identify adults with PA with hypertension and diabetes comorbidities and then compared to non-PA patients. The primary outcome was in-hospital death. Secondary outcomes included ischemic stroke, hemorrhagic stroke, acute renal failure, atrial fibrillation, and acute heart failure. Results: A total of 48,434,503 patients with hypertension and diabetes were included in the analysis, of whom 12,850 (0.03%) were diagnosed with primary hyperaldosteronism (PA). Compared to patients with hypertension and diabetes but no PA, those with PA were more likely to be younger [63(13) vs. 67 (14), male (57.1% vs. 48.3%), and African-Americans (32% vs. 18.5%) (p<0.001 for all). PA was associated with a higher risk of mortality (adjusted OR 1.076 [1.076-1.077]), ischemic stroke [adjusted OR 1.049 (1.049-1.05)], hemorrhagic stroke [adjusted OR 1.05 (1.05-1.051)], acute renal failure [adjusted OR 1.058 (1.058-1.058)], acute heart failure [OR 1.104 (1.104-1.104)], and atrial fibrillation [adjusted OR 1.034 (1.033-1.034)]. As expected, older age and underlying cardiovascular disease were the strongest predictors of mortality. However, the female gender conferred protection [OR 0.889 (0.886-0.892]. Conclusion: Primary hyperaldosteronism in patients with hypertension and diabetes is associated with increased mortality and morbidity.

Characteristics and predictors of out-of-hospital cardiac arrest in young adults hospitalized with acute coronary syndrome: A retrospective cohort study of 30,000 patients in the Gulf region.

INTRODUCTION: The characteristics of young adults with out-of-hospital cardiac arrest (OHCA) due to acute coronary syndrome (ACS) has not been well described. The mean age of gulf citizens in ACS registries is 10-15 years younger than their western counterparts, which provided us with a unique opportunity to investigate the characteristics and predictors of OHCA in young adults presenting with ACS. METHODOLOGY: This was a retrospective cohort study using data from 7 prospective ACS registries in the Gulf region. In brief, all registries included consecutive adults who were admitted with ACS. OHCA was defined as cardiac arrest upon presentation (i.e., before admission to the hospital). We described the characteristics of young adults (< 50 years) who had OHCA and performed multivariate logistic regression analysis to assess independent predictors of OHCA. RESULTS: A total of 31,620 ACS patients were included in the study. There were 611 (1.93%) OHCA cases in the whole cohort [188/10,848 (1.73%) in young adults vs 423/20,772 (2.04%) in older adults, p = 0.06]. Young adults were predominantly males presenting with ST-elevation myocardial infarction (STEMI) [182/188 (96.8%) and 172/188 (91.49%), respectively]. OHCA was the sentinel event of coronary artery disease (CAD) in 70% of young adults. STEMI, male sex, and non-smoking status were found to be independent predictors of OHCA [OR = 5.862 (95% CI 2.623-13.096), OR: 4.515 (95% CI 1.085-18.786), and OR = 2.27 (95% CI 1.335-3.86), respectively]. CONCLUSION: We observed a lower prevalence of OHCA in ACS patients in our region as compared to previous literature from other regions. Moreover, OHCA was the sentinel event of CAD in the majority of young adults, who were predominantly males with STEMIs. These findings should help risk-stratify patients with ACS and inform further research into the characteristics of OHCA in young adults.

Smoking in Acute Myocardial Infarction Patients: Observations from a Registry Heart Hospital, Qatar.

Introduction: Studies from the US and Europe showed a decline in smoking among patients with acute myocardial infarction (AMI), but limited data are available from the Middle East. In this study, we describe the temporal trend in the prevalence, associated risk factors, and outcomes of smoking among patients with AMI in Qatar. Materials and Methods: A total of 27,648 AMI patients were analyzed from the cardiology registry at Heart Hospital, Doha, Qatar. This spans from January 1991 to May 2022. Results: Of the total, 13,562 patients (49.1%, 95% confidence interval [CI]: 48%-50%) were smokers, with a clear majority of males (98.5%). Smoking habit was found to decrease in AMI patients with increasing age (age 51-60 years, adjusted odds ratio [OR]: 0.71, 95% CI: 0.67-0.76, P = 0.001, and age ≥61 years, adjusted OR: 0.45, 95% CI: 0.42-0.48, P = 0.001, in comparison to age ≤50 years). Smoking was associated with a lower risk of inhospital mortality (adjusted OR: 0.61, 95% CI: 0.54-0.70, P = 0.001), but triglyceride, obesity, and old myocardial infarction risk factors were associated with a higher risk. A decreasing trend in current smoking habits in each quantile of the 1996-2000 year (adjusted OR: 0.82, 95% CI: 0.71-0.93, P = 0.001), 2001-2005 year (adjusted OR: 0.70, 95% CI: 0.62-0.80, P = 0.001), 2006-2010 year (adjusted OR: 0.75, 95% CI: 0.67-0.84, P = 0.001), 2011-2015 year (adjusted OR: 0.48, 95% CI: 0.42-0.54, P = 0.001), 2016-2020 year (adjusted OR: 0.48, 95% CI: 0.43-0.54, P = 0.001), and ≥2021 year (adjusted OR: 0.46, 95% CI: 0.40-0.53, P = 0.001) was observed in comparison to the quantile 1991-1995 year. Similar results were also observed in the young population (age ≤50 years) including the non-Qataris, who had 25% more smokers in comparison to Qatari nationals. Conclusion: Smoking trended down significantly; however, it remained prevalent in 50% of patients among AMI patients. Smokers were younger, with fewer traditional risk factors, and had lower inhospital mortality.

Atrioventricular Conduction Disorders as a Complication of Inferior ST-Elevation Myocardial Infarction in Patients with COVID-19 Infection.

This case series demonstrates how COVID-19 infection might affect the heart in the context of acute myocardial infarction. Atrioventricular (AV) block might appear as one of the significant cardiac complications of acute MI in patients who tested COVID-19 PCR positive regardless of the presence of CVOID-19 infection symptoms. In our series, conduction disorders as a complication of acute inferior STEMI are more common in patients who tested positive for the COVID-19 infection. 11 patients out of 18 inferior STEMI patients who have tested positive for the COVID-19 infection have atrioventricular block disorders.

Diabetes outcomes in heart failure patients with hypertrophic cardiomyopathy.

Aims: We aimed to assess diabetes outcomes in heart failure (HF) patients with hypertrophic cardiomyopathy (HCM). Methods: The National Inpatient Sample database was analyzed to identify records from 2005 to 2015 of patients hospitalized for HF with concomitant HCM. We examined the prevalence of diabetes in those patients, assessed the temporal trend of in-hospital mortality, ventricular fibrillation, atrial fibrillation, and cardiogenic shock and compared diabetes patients to their non-diabetes counterparts. Results: Among patients with HF, 0.26% had HCM, of whom 29.3% had diabetes. Diabetes prevalence increased from 24.8% in 2005 to 32.7% in 2015. The mean age of patients with diabetes decreased from 71 ± 13 to 67.6 ± 14.2 (p < 0.01), but the prevalence of cardiovascular risk factors significantly increased. In-hospital mortality decreased from 4.3% to 3.2% between 2005 and 2015. Interestingly, cardiogenic shock, VF, and AF followed an upward trend. Age (OR = 1.04 [1.03-1.05]), female gender (OR = 1.50 [0.72-0.88]), and cardiovascular risk factors were associated with a higher in-hospital mortality risk in diabetes. Compared to non-diabetes patients, the ones with diabetes were younger and had more comorbidities. Unexpectedly, the adjusted risks of in-hospital mortality (aOR = 0.88 [0.76-0.91]), ventricular fibrillation (aOR = 0.79 [0.71-0.88]) and atrial fibrillation (aOR 0.80 [0.76-0.85]) were lower in patients with diabetes, but not cardiogenic shock (aOR 1.01 [0.80-1.27]). However, the length of stay was higher in patients with diabetes, and so were the total charges per stay. Conclusion: In total, we observed a temporal increase in diabetes prevalence among patients with HF and HCM. However, diabetes was paradoxically associated with lower in-hospital mortality and arrhythmias.

Khat Chewing and Cardiovascular Disease.

Khat chewing is a deeply rooted habit in Yemen. It has social, economic, and medical problems. Chronic use of khat chewing increases the risk of many medical complications. Cathinone, the main khat leaf constituent, has an indirect sympathomimetic action. The effect of khat chewing and cathinone on the cardiovascular system have been identified, including increased risk of hypertension and acute cardiovascular events, as well as increased risk of cardiovascular complications among patients presenting with Acute Coronary Syndrome who are khat chewers.

Gender Association with Incidence, Clinical Profile, and Outcome of Out-of-Hospital Cardiac Arrest: A Middle East Perspective.

Background: Out-of-hospital cardiac arrest (OHCA) is a leading cause of death worldwide. However, there is limited information on the outcome of the OHCA in the Middle East population, and limited studies have been carried out in the Arab Gulf countries. Hence, we aim to study the incidence and rate of survival in the OHCA setting and to assess the impact of gender on the clinical outcome following OHCA. Methods: Retrospective analysis of a prospective registry of all eligible, consecutive, and nontraumatic adult patients who successfully resuscitated (return of spontaneous circulation) from "Cardiac Arrest" occurring outside the hospital, Hospitalized in Doha, Qatar from January 1991 to June 2010. Results: A total of 41,453 consecutive patients were admitted during the study, of whom 987 (2.4%) had a diagnosis of OHCA. Among them, 269 (27.3%) were women and 718 (72.7%) were men. Although the mortality rate was higher in females than in males (65.4% vs. 57.7%, P = 0.03), the logistic regression analysis did not show gender as an independent predictor of death in this clinical setting. Conclusion: In this sample of the state population, women who have OHCAs had a lower rate of survival, but gender was not an independent predictor of mortality following OHCA.

Validation of Polygenic Risk Scores for Coronary Heart Disease in a Middle Eastern Cohort Using Whole Genome Sequencing.

BACKGROUND: Enthusiasm for using polygenic risk scores (PRSs) in clinical practice is tempered by concerns about their portability to diverse ancestry groups, thus motivating genome-wide association studies in non-European ancestry cohorts. METHODS: We conducted a genome-wide association study for coronary heart disease in a Middle Eastern cohort using whole genome sequencing and assessed the performance of 6 PRSs developed with methods including LDpred (PGS000296), metaGRS (PGS000018), Pruning and Thresholding (PGS000337), and an EnsemblePRS we developed. Additionally, we evaluated the burden of rare variants in lipid genes in cases and controls. Whole genome sequencing at 30× coverage was performed in 1067 coronary heart disease cases (mean age=59 years; 70.3% males) and 6170 controls (mean age=40 years; 43.5% males). RESULTS: The majority of PRSs performed well; odds ratio (OR) per 1 SD increase (OR1sd) was highest for PGS000337 (OR1sd=1.81, 95% CI [1.66-1.98], P=3.07×10-41). EnsemblePRS performed better than individual PRSs (OR1sd=1.8, 95% CI [1.66-1.96], P=5.89×10-44). The OR for the 10th decile versus the remaining deciles was >3.2 for PGS000337, PGS000296, PGS000018, and reached 4.58 for EnsemblePRS. Of 400 known genome-wide significant loci, 33 replicated at P<10-4. However, the 9p21 locus did not replicate. Six suggestive (P<10-5) new loci/genes with plausible biological function were identified (eg, CORO7, RBM47, PDE4D). The burden of rare functional variants in LDLR, APOB, PCSK9, and ANGPTL4 was greater in cases than controls. CONCLUSIONS: Overall, we demonstrate that PRSs derived from European ancestry genome-wide association studies performed well in a Middle Eastern cohort, suggesting these could be used in the clinical setting while ancestry-specific PRSs are developed.

Hypoglycemia is associated with a higher risk of mortality and arrhythmias in ST-elevation myocardial infarction, irrespective of diabetes.

Aims: We aimed to assess the impact of hypoglycemia in ST-elevation myocardial infarction (STEMI). Background: Hypoglycemia increases the risk of mortality in patients with diabetes and high cardiovascular risk. Methods: We used the National Inpatient Sample (2005-2017) database to identify adult patients with STEMI as the primary diagnosis. The secondary diagnosis was hypoglycemia. We compared cardiovascular and socio-economic outcomes between STEMI patients with and without hypoglycemia and assessed temporal trends. Results: Hypoglycemia tends to complicate 0.17% of all cases hospitalized for STEMI. The mean age (±SD) of STEMI patients hospitalized with hypoglycemia decreased from 67 ± 15 in 2005 to 63 ± 12 in 2017 (p = 0.046). Mortality was stable with time, but the prevalence of ventricular tachycardia, ventricular fibrillation, acute renal failure, cardiogenic shock, total charges, and length of stay (LOS) increased with time (p < 0.05 for all). Compared to non-hypoglycemic patients, those who developed hypoglycemia were older and more likely to be black; only 6.7% had diabetes compared to 28.5% of STEMI patients (p = 0.001). Cardiovascular events were more likely to occur in hypoglycemia: mortality risk increased by almost 2.5-fold (adjusted OR = 2.625 [2.095-3.289]). There was a higher incidence of cardiogenic shock (adjusted OR = 1.718 [1.387-2.127]), atrial fibrillation (adjusted OR = 1.284 [1.025-1.607]), ventricular fibrillation (adjusted OR = 1.799 [1.406-2.301]), and acute renal failure (adjusted OR = 2.355 [1.902-2.917]). Patients who developed hypoglycemia were less likely to have PCI (OR = 0.596 [0.491-0.722]) but more likely to have CABG (OR = 1.792 [1.391-2.308]). They also had a longer in-hospital stay and higher charges/stay. Conclusion: Hypoglycemia is a rare event in patients hospitalized with STEMI. However, it was found to have higher odds of mortality, arrhythmias, and other comorbidities, irrespective of diabetes.

Comparison of in-hospital and out-of-hospital cardiac arrest of trauma patients in Qatar.

BACKGROUND: Cardiac arrests in admitted hospital patients with trauma have not been described in the literature. We defined "in-hospital cardiac arrest of a trauma" (IHCAT) patient as "cessation of circulatory activity in a trauma patient confirmed by the absence of signs of circulation or abnormal cardiac arrest rhythm inside a hospital setting, which was not cardiac re-arrest." This study aimed to compare epidemiology, clinical presentation, and outcomes between in- and out-of-hospital arrest resuscitations in trauma patients in Qatar. It was conducted as a retrospective cohort study including IHCAT and out-of-hospital trauma cardiac arrest (OHTCA) patients from January 2010 to December 2015 utilizing data from the national trauma registry, the out-of-hospital cardiac arrest registry, and the national ambulance service database. RESULTS: There were 716 traumatic cardiac arrest patients in Qatar from 2010 to 2015. A total of 410 OHTCA and 199 IHCAT patients were included for analysis. The mean annual crude incidence of IHCAT was 2.0 per 100,000 population compared to 4.0 per 100,000 population for OHTCA. The univariate comparative analysis between IHCAT and OHTCA patients showed a significant difference between ethnicities (p=0.04). With the exception of head injury, IHCAT had a significantly higher proportion of localization of injuries to anatomical regions compared to OHTCA; spinal injury (OR 3.5, 95% CI 1.5-8.3, p<0.004); chest injury (OR 2.62, 95% CI 1.62-4.19, p<0.00), and abdominal injury (OR 2.0, 95% CI 1.0-3.8, p<0.037). IHCAT patients had significantly higher hypovolemia (OR 1.66, 95% CI 1.18-2.35, p=0.004), higher mean Glasgow Coma Scale (GCS) score (OR 1.4, 95% CI 1.3-1.6, p<0.00), and a greater proportion of initial shockable rhythm (OR 3.51, 95% CI 1.6-7.7, p=0.002) and cardiac re-arrest (OR 6.0, 95% CI 3.3-10.8, p=<0.00) compared to OHTCA patients. Survival to hospital discharge was greater for IHCAT patients compared to OHTCA patients (OR 6.3, 95% CI 1.3-31.2, p=0.005). Multivariable analysis for comparison after adjustment for age and gender showed that IHCAT was associated with higher odds of spinal injury, abdominal injury, higher pre-hospital GCS, higher occurrence of cardiac re-arrest, and better survival than for OHTCA patients. IHCAT patients had a greater proportion of anatomically localized injuries indicating solitary injuries compared to greater polytrauma in OHTCA. In contrast, OHTCA patients had a higher proportion of diffuse blunt non-localizable polytrauma injuries that were severe enough to cause immediate or earlier onset of cardiac arrest. CONCLUSION: In traumatic cardiac arrest patients, IHCAT was less common than OHTCA and might be related to a greater proportion of solitary localized anatomical blunt injuries (head/abdomen/chest/spine). In contrast, OHTCA patients were associated with diffuse blunt non-localizable polytrauma injuries with increased severity leading to immediate cardiac arrest. IHCAT was associated with a higher mean GCS score and a higher rate of initial shockable rhythm and cardiac re-arrest, and improved survival rates.

The Prevalence and Genetic Spectrum of Familial Hypercholesterolemia in Qatar Based on Whole Genome Sequencing of 14,000 Subjects.

Familial hypercholesterolemia (FH) is an inherited disease characterized by reduced efficiency of low-density lipoprotein-cholesterol (LDL-C) removal from the blood and, consequently, an increased risk of life-threatening early cardiovascular complications. In Qatar, the prevalence of FH has not been determined and the disease, as in many countries, is largely underdiagnosed. In this study, we combined whole-genome sequencing data from the Qatar Genome Program with deep phenotype data from Qatar Biobank for 14,056 subjects to determine the genetic spectrum and estimate the prevalence of FH in Qatar. We used the Dutch Lipid Clinic Network (DLCN) as a diagnostic tool and scrutinized 11 FH-related genes for known pathogenic and possibly pathogenic mutations. Results revealed an estimated prevalence of 0.8% (1:125) for definite/probable cases of FH in the Qatari population. We detected 16 known pathogenic/likely pathogenic mutations in LDLR and one in PCSK9; all in a heterozygous state with high penetrance. The most common mutation was rs1064793799 (c.313+3A >C) followed by rs771019366 (p.Asp90Gly); both in LDLR. In addition, we identified 18 highly penetrant possibly pathogenic variants, of which 5 were Qatari-specific, in LDLR, APOB, PCSK9 and APOE, which are predicted to be among the top 1% most deleterious mutations in the human genome but further validations are required to confirm their pathogenicity. We did not detect any homozygous FH or autosomal recessive mutations in our study cohort. This pioneering study provides a reliable estimate of FH prevalence in Qatar based on a significantly large population-based cohort, whilst uncovering the spectrum of genetic variants associated with FH.