Ahmed Al-Motarreb

Objective: To determine whether obesity was associated with chest pain rather than dyspnea-only presentation among Yemeni adults with angina and nonobstructive coronary arteries (ANOCA) and to explore differences in cardiovascular risk factors, laboratory parameters, routine echocardiographic and angiographic findings, and medication exposure according to obesity status. Methodology: This hospital-based cross-sectional study included 151 consecutive Yemeni adults undergoing elective invasive coronary angiography. Eligible participants presented with chest pain or dyspnea considered an angina-equivalent symptom and had either no visible epicardial coronary stenosis or <50% stenosis in all major epicardial vessels. Obesity was defined as body mass index ≥30 kg/m². Seven participants with overlapping chest pain and dyspnea indicators were excluded only from the primary presentation-specific analysis, leaving 144 participants. Results: Of 151 participants, 49 (32.5%) were obese. Among the 144 participants with an unambiguous symptom classification, 108 (75.0%) presented with chest pain and 36 (25.0%) with dyspnea without chest pain. Chest-pain presentation occurred in 38/49 obese participants (77.6%) and 70/95 non-obese participants (73.7%; p=0.612). Obesity was not associated with chest-pain presentation after adjustment for age, sex, diabetes mellitus, and hypertension (aOR 1.21, 95% CI 0.53–2.78; p=0.648). A sensitivity analysis including all 151 participants produced a similar result (aOR 1.11, 95% CI 0.49–2.54; p=0.802). In exploratory analyses, obese participants had higher median LDL-C (120.0 vs 110.5 mg/dL; p=0.007), lower median HDL-C (37.0 vs 42.0 mg/dL; p=0.027), and a greater prevalence of HDL-C <40 mg/dL (55.1% vs 33.3%; p=0.011). Laboratory-defined composite dyslipidemia and routine echocardiographic and angiographic findings did not differ significantly between obesity groups. Conclusions: Obesity was not statistically associated with chest pain rather than dyspnea-only presentation among Yemeni adults with ANOCA. Differences in LDL-C and HDL-C were observed in exploratory analyses but require confirmation.

Objective: This study aimed to investigate the circadian pattern of AMI symptom onset among habitual khat chewers and to evaluate differences in clinical presentation, angiographic findings, and in-hospital outcomes according to periods of active khat exposure. Methodology: This prospective observational study enrolled 200 consecutive habitual khat chewers with confirmed AMI who were admitted to the Cardiac Center of Al-Thawra General Teaching Hospital, Sana’a, Yemen, between January and September 2024. Symptom onset times were analyzed across the 24-hour cycle and categorized into a khat-inactive period (00:01–14:59) and a khat-effective period (15:00–00:00). Results: AMI symptom onset demonstrated a non-uniform circadian distribution, with clustering during the early morning and late evening/night hours. Of the 200 participants, 109 (54.5%) experienced symptom onset during the khat-effective period and 91 (45.5%) during the khat-inactive period, with no significant difference in overall distribution (p = 0.203). Baseline demographic, clinical, behavioral, and angiographic characteristics were largely comparable between groups. However, acute heart failure occurred significantly more frequently among patients presenting during the khat-effective period than among those presenting during the khat-inactive period (14.7% vs. 5.5%, p = 0.035). Similarly, cardiogenic shock was more common during the khat-effective period (12.8% vs. 2.2%, p = 0.006). No independent clinical or behavioral predictors of symptom onset during the khat-effective period were identified in multivariable analysis. Conclusions: Among habitual khat chewers, AMI symptom onset exhibited a distinctive circadian pattern characterized by clustering during the early morning and late evening/night hours. Although the overall distribution of events did not differ significantly between khat activity periods, symptom onset during the khat-effective period was associated with a higher incidence of acute heart failure and cardiogenic shock.

Objective: To evaluate the clinical characteristics, angiographic findings, procedural performance, and in-hospital outcomes of Yemeni patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). Methodology: A prospective observational study was conducted at the Cardiac Center of Al-Thawra Modern General Hospital, Sana’a, Yemen, between November 2023 and April 2024. Consecutive adult patients diagnosed with STEMI and treated with primary PCI were enrolled. Demographic characteristics, cardiovascular risk factors, clinical presentation, laboratory findings, angiographic features, procedural outcomes, and in-hospital clinical outcomes were collected using standardized data collection forms. Results: A total of 160 patients underwent primary PCI during the study period. The mean age was 56 ± 9 years, and 80.6% of patients were male. Khat chewing was the most prevalent cardiovascular risk factor (86.9%), followed by tobacco use (74.4%) and diabetes mellitus (40.0%). The median symptom-to-door time was 300 minutes (IQR: 180–480), while the median door-to-balloon time was 180 minutes (IQR: 120–300). The left anterior descending artery was the most common culprit vessel (55.0%), and single-vessel disease was present in 63.8% of patients. Procedural success was achieved in 82.5% of cases, and significant post-procedural ST-segment resolution occurred in 71.3% of patients. In-hospital mortality was 7.5%, while major adverse cardiovascular events (MACE) occurred in 22.5% of patients. Cardiogenic shock, acute heart failure, and ventricular arrhythmias occurred in 4.4%, 4.4%, and 5.0% of patients, respectively. Conclusion: Primary PCI appears to be an effective reperfusion strategy for STEMI management in Yemen despite substantial healthcare system challenges. However, prolonged prehospital and in-hospital treatment delays remain common and may adversely influence clinical outcomes.

Objectives: This study aimed to compare the clinical characteristics, risk factors, management strategies, and in-hospital outcomes of young acute coronary syndrome (ACS) patients (≤45 years) with those of older adults, addressing a significant evidence gap in the region. Methodology: This cross-sectional study included all consecutive patients presenting with ACS. Data were collected on demographics, cardiovascular risk factors, clinical presentation, angiographic findings, treatment modalities, and in-hospital outcomes. Comparative analyses between age groups were performed, and multivariable logistic regression identified predictors of in-hospital mortality. Results: Among 310 ACS patients, 23.2% were ≤45 years. Young adults demonstrated a distinctive risk profile characterized by significantly higher prevalence of khat chewing, smoking, and family history of premature coronary artery disease, whereas diabetes mellitus was more common among older adults (p < 0.05). Younger patients more frequently underwent coronary angiography and PCI, while older patients were managed more conservatively (p < 0.05). Single-vessel disease was predominant in younger individuals, contrasting with greater multivessel involvement in older patients. Although overall complication and mortality rates were comparable between groups, older adults exhibited higher GRACE scores and more frequent heart failure. Independent predictors of in-hospital mortality—including low systolic blood pressure, elevated serum creatinine, reduced LVEF, multivessel disease, and delayed symptom-to-door time—were consistent across age groups. PCI was independently protective. Conclusion: Young Yemeni adults with ACS exhibit unique behavioral and familial risk patterns but share similar mortality risk predictors with older patients. These findings highlight an urgent need for targeted prevention strategies addressing modifiable behaviors—especially smoking and khat chewing.

Background: Percutaneous coronary intervention (PCI) is increasingly used in the management of acute coronary syndromes (ACSs). PCI has decreased the demand for coronary artery bypass grafting, and more patients with ACS are now undergoing PCI. No previous data about the characteristics and outcome of patients performing PCI in Yemen. This study aimed to assess the patient presentation, characteristics, and outcome among Yemeni patients having PCI in the Military Cardiac Center. Methods: All patients who underwent PCI either primary or elective in the Military Cardiac Center in Sanaa City were included over 6 months. Clinical, demographic, procedural, and outcome data were extracted and analyzed. Results: During the study period, 250 patients underwent PCI. The mean ± standard deviation age was 57 ± 11 years, with 84% being male. Of all the patients, 61.6% (156) smoked tobacco, 56% (140) had hypertension, 37% (93) had Type 2 diabetes, 48.4% (121) had hyperlipidemia, and 8% (20) had a family history of ischemic heart disease. Coronary artery presentation was in the form of acute ST-elevation myocardial infarction at 41% (102), non-STEMI at 5.2% (58), stable angina at 31% (77), and unstable angina at 5.2% (13). Coronary artery interventions were elective PCI in 81% (203), emergency in 11% (27), and urgent in 8% (20) with only 3% radial artery access and 97% femoral access. PCI was mainly in the left anterior descending artery in 82% (179), right coronary artery in 41% (89), left circumflex artery in 23% (54), and left main in 1.25% (3). All stents were drug-eluting stents during the registry time. Complication occurred in 17.6% (44) and case fatality was 2% (5). Conclusions: Despite the current situation in Yemen, PCI was performed with success in a large number of patients with a low incidence of inhospital complications and mortality that is comparable to high- or middle-income settings.

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.

Little is known about the predictors and prognostic impact of recurrent in-hospital ischemia and infarction in patients with acute coronary syndrome (ACS). Our objectives were to determine the baseline characteristics, risk factors, and long-term outcomes of patients with recurrent myocardial infarction (Re-MI). We evaluated patients with ACS who were enrolled in the second Gulf Registry of Acute Coronary Events from October 2008 to June 2009. Of 7925 patients with ACS, 167 (2.1%) developed in-hospital Re-MI. Patients with Re-MI were older (mean age: 58.7 ± 13.4 vs 56.8 ± 12.6; P = .045), had higher rates of hyperlipidemia (42.5% vs 32.6%; P = .019), and were more likely to present with ST-segment elevation myocardial infarction (STEMI; 74.25% vs 43.9%; P < .001) and Killip class 4 (8.4% vs 3.2%; P < .001) than patients without Re-MI. Patients with Re-MI were less likely to receive evidence-based therapies upon admission, including aspirin (94.6% vs 98.5%; P < .001), β-blockers (59.3% vs 74.7%; P < .001), and statins (86.8% vs 94.9%; P < .001), and were less frequently assessed with coronary angiography (29.3% vs 32.5%; P = .029). Predictors of recurrent events included history of angina, hypotension on presentation, admission diagnosis of STEMI, and decreased use of evidence-based therapies including aspirin, statins, and β-blockers upon admission. Patients with Re-MI had more in-hospital complications, including congestive heart failure (44.3% vs 12.4%) and cardiogenic shock (26.4% vs 5.3%), as well as higher mortality rates during hospitalization (23.4% vs 4.1%) and after a discharge period of 30 days (27% vs 7.8%) and 1 year (30.5% vs 11.7%; P < .001 for all comparisons). In our study, patients with Re-MI were less likely to receive evidence-based therapies and had a worse prognosis in terms of in-hospital complications and higher mortality rates. High-risk patients should be monitored and managed differently to prevent secondary attacks.

Background: The purpose of this study was to report the prevalence, clinical characteristics, contributing factors, management and outcome of patients with chronic obstructive pulmonary disease (COPD) among patients hospitalized with heart failure (HF). Methods: Data were derived from Gulf Care (Gulf acute heart failure registry), a prospective multicenter study of 5005 consecutive patients hospitalized with acute heart failure during February to November 2012 in seven Middle Eastern countries. Data were described and compared for demographics, management and outcomes. Results: The prevalence of COPD among HF patients was 10%. COPD patients were older, more likely to be female and to have diabetes, hypertension, chronic kidney disease and sleep apnea (P = 0.001 for all) when compared to non-COPD patients. Contributing factors for hospitalization were systemic infection and atrial arrhythmias in COPD patients compared to acute coronary syndrome, uncontrolled hypertension and anemia in the non-COPD patients. Left-ventricular ejection fraction was higher in COPD patients; while BNP levels were comparable between the two groups. Non-invasive ventilation was used more frequently among COPD patients compared to non-COPD patients (P = 0.001). On multivariate logistic regression analysis, COPD was not associated with increased risk in-hospital and one-year death among acute heart failure (AHF) population and β blockers treatment appear to have neutral mortality effect in COPD patients with HF. Conclusion: COPD have distinct cardiovascular risk profile and precipitating factors for hospitalization with HF when compared to non-COPD patients. COPD history had no impact on the short-term and one-year mortality.