Ahmad Hersi

Background: Acute kidney injury critically impacts outcomes in cardiogenic shock secondary to acute myocardial infarction (CS-AMI). Acute kidney injury is one of the strongest independent predictors of in-hospital mortality in CS-AMI. Despite evidence that early renal replacement therapy (RRT) initiation improves survival, comprehensive prediction models for RRT in this population remain lacking. Objective: This study aimed to develop and internally validate a Least Absolute Shrinkage and Selection Operator (LASSO) regression–based prediction model and clinical nomogram for in-hospital RRT in patients with CS-AMI. Methods: This multicenter retrospective cohort study included 1431 patients with CS-AMI from the Gulf Cardiogenic Shock (Gulf-CS) registry across 13 centers in 6 Gulf countries (2020‐2022). LASSO logistic regression was applied to a training set (1071/1431, 80%) to select baseline predictors of RRT; performance was evaluated on a held-out testing set (268/1431, 20%). Internal validation included 10-fold cross-validation and bootstrapping (1000 iterations). Cluster-robust SEs accounted for center effects. The model was compared to a parsimonious model (age+creatinine clearance), and a clinical nomogram was developed. Results: Of 1431 patients, 190 (13.3%) required RRT. Patients requiring RRT were significantly older (mean 64.17, SD 12.14 y vs mean 59.75, SD 11.77 y; P <.001), with higher prevalences of diabetes mellitus (72.1% vs 61.9%; P =.008), peripheral arterial disease (11.6% vs 3.7%; P <.001), and prior cerebrovascular accident (11.1% vs 5.7%; P =.005). The RRT group had lower creatinine clearance (46 vs 72 mL/min; P <.001), higher baseline lactate (2.7 vs 2.1 mmol/L; P <.001), and more advanced Society for Cardiovascular Angiography and Interventions (SCAI) shock stages (stages D and E: 90.5% vs 64.9%; P <.001). LASSO selected 15 baseline predictors. The model achieved an area under the receiver operating characteristic curve (AUC) of 0.714 on the testing set, significantly outperforming the parsimonious model (AUC: 0.624; P <.001). Bootstrap-corrected AUC was 0.745 (95% CI 0.730‐0.756). In-hospital mortality was markedly higher in the RRT group (75.8% vs 38.8%; P <.001), with longer hospital stay (10 vs 6 d; P <.001), more major bleeding (16.8% vs 7.3%; P <.001), and cerebrovascular accidents (11.1% vs 4.9%; P =.001). Conclusions: We have developed and internally validated a robust 15-variable nomogram (Gulf-CS-Nomogram) that accurately predicts the need for RRT in patients with CS-AMI using baseline data intended for use after coronary angiography. This tool may facilitate early nephrology consultation and timely RRT initiation to improve outcomes.

The role of invasive hemodynamic monitoring on the outcomes of cardiogenic shock in patients with acute myocardial infarction (AMI-CS) is controversial. We evaluated whether invasive hemodynamic monitoring improved in-hospital mortality in patients with AMI-CS. This study analyzed 1513 patients with AMI-CS presenting between 2020 and 2022. Patients were classified into 2 groups on the basis of invasive monitoring. Patients receiving invasive hemodynamic monitoring (n = 602) were more likely to present with advanced cardiogenic shock stages, cardiac arrest, bradyarrhythmias, and required more mechanical ventilation and renal support. Propensity score identified 488 matched pairs. Escalation of mechanical support was greater in patients who received noninvasive monitoring (14% vs 7%; P < .001). There was no difference in mortality among the matched patients (49.0% vs 49.182%, P > .99). Hospital stay was longer in patients who received invasive monitoring (median 7 vs 6 days; P = .016). In patients receiving invasive monitoring, the cardiac index, pulmonary artery capillary wedge pressure, and right atrial pressure and the use of Swan-Ganz did not predict mortality. In AMI-CS, invasive hemodynamic monitoring was not associated with improved outcomes compared with routine monitoring. These findings highlight the inconsistent evidence surrounding monitoring methods, underscoring the need for further research to inform clinical decision-making.

Background: Previous registries have shown a younger average age at presentation with cardiovascular diseases in the Middle East (ME), but no study has examined atrioventricular block (AVB). Moreover, these comparisons are confounded by younger populations in the ME. We sought to describe the average age at presentation with AVB in ME and quantify the effect of being from ME, adjusted for the overall younger population. Methodology: This was a retrospective analysis of PANORAMA registries, which collected data on patients who underwent cardiac rhythm device placement worldwide. Countries with a median population age of ≤30 were considered ‘young countries’. Multivariate linear regression was performed to assess the effect of being from ME, adjusted for being from a ‘young country’, on age at presentation with AVB. Results: The study included 5,259 AVB patients, with 640 (8.2%) from the ME. Mean age at presentation was seven years younger in ME than in other regions (62.9 ± 17.8 vs. 70 ± 14.1, P < 0.001). Being from a ‘young country’ was associated with 5.6 years younger age at presentation (95%CI –6.5––4.6), whereas being from ME was associated with 3.1 years younger age at presentation (95%CI –4.5––1.8), (P < 0.001 for both). Conclusion: The average age at presentation with AVB in the ME is seven years younger than in other regions. While this is mostly driven by the overall younger population, being from the ME appears to be independently associated with younger age. Determinants of the earlier presentation in ME need to be assessed, and care should be taken when applying international recommendations.

Currently, gender is not considered in the choice of the revascularization strategy for patients with unprotected left main coronary artery (ULMCA) disease. This study analyzed the effect of gender on the outcomes of percutaneous coronary intervention (PCI) vs coronary artery bypass grafting (CABG) in patients with ULMCA disease. Females who had PCI (n = 328) were compared with females who had CABG (n = 132) and PCI in males (n = 894) was compared with CABG (n = 784). Females with CABG had higher overall hospital mortality and major adverse cardiovascular events (MACE) than females with PCI. Male patients with CABG had higher MACE; however, mortality did not differ between males with CABG vs PCI. In female patients, follow-up mortality was significantly higher in CABG patients, and target lesion revascularization was higher in patients with PCI. Male patients had no difference in mortality and MACE between groups; however, MI was higher with CABG, and congestive heart failure was higher with PCI. In conclusion, women with ULMCA disease treated with PCI could have better survival with lower MACE compared with CABG. These differences were not evident in males treated with either CABG or PCI. PCI could be the preferred revascularization strategy in women with ULMCA disease.

Background: E-government platforms provide an opportunity to use a novel data source for population health surveillance (also known as e-health). Absher is a Saudi e-government platform with 23 million authenticated users, including residents and citizens in Saudi Arabia. All Absher users were invited to participate in a web-based survey to estimate the prevalence of noncommunicable diseases and their risk factors in Saudi Arabia.Objective: To assess the potential of using an e-government platform (Absher) to administer web-based health surveys.Methods: A cross-sectional, web-based health survey was administered to Absher users between April 2019 and March 2020. The survey instrument included eight items and took <5 min to complete. The respondents' data were compared to Saudi Arabia's 2016 census. Descriptive summary statistics of the prevalence of major noncommuncable diseases are presented and compared to population-based prevalence data from Saudi Arabia's World Health Survey (WHS) 2019. All analysis was conducted using Stata 13.0.Results: Overall, the Absher health survey had a 24.6% response rate, with most respondents being male (84%), Saudi (67%), and between 30 and 44 years of age (49%). Overall, the prevalence of noncommunicable diseases and risk factors among respondents was high for overweight (35%) and obesity (30%) and low for asthma (6%). The prevalence of diabetes, dyslipidemia, and hypertension was between 15 and 17% on average, and 26.5% were smokers. In comparison to population-based World Health Survey estimates, the Absher survey overestimated obesity, diabetes, dyslipidemia, hypertension, and smoking rates, and underestimated overweight, whereas asthma prevalence was similar for Absher and the WHS.Conclusions: With improvements in the study design, the use of e-government platforms can provide a useful and potentially low-cost data source for public health research.

The optimal stenting strategy for unprotected left main coronary artery (ULMCA) disease remains debated. This retrospective observational study (Gulf Left Main Registry) analyzed the outcomes of 1 vs 2 stents in patients with unprotected left main percutaneous coronary intervention (PCI). Overall, 1222 patients were evaluated; 173 had 1 stent and 1049 had 2 stents. The 2-stent group was older with more comorbidities, higher mean SYNTAX scores, and more distal bifurcation lesions. In the 1-stent group, in-hospital events were significant for major bleeding, and better mean creatinine clearance. At median follow-up of 20 months, the 1-stent group was more likely to have target lesion revascularization (TLR). Total mortality was numerically lower in the 1-stent group (.00% vs 2.10%); however, this was not statistically significant ( P=.068). Our analysis demonstrates the benefits of a 2-stent approach for ULMCA patients with high SYNTAX scores and lesions in both major side branches, while the potential benefit of a 1-stent approach for less complex ULMCA was also observed. Further studies with longer follow-up are needed to definitively demonstrate the optimal approach.

Background: Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome (ACS) and sudden cardiac death. Physical or emotional stressors are the most commonly reported triggers for SCAD. Unemployment has been identified as a source of emotional stress and is linked to poor mental and physical health. Objective: To examine the association between employment status and in-hospital and follow-up adverse cardiovascular events in patients with SCAD. Methods: We conducted a retrospective, multi-center, observational study of patients undergoing coronary angiography for ACS between January 2011 and December 2017. The total number of patients enrolled was 198,000. Patients were diagnosed with SCAD based on angiographic and intravascular imaging modalities whenever available. There were 83 patients identified with SCAD from 30 medical centers in 4 Arab gulf countries. In-hospital (myocardial infarction, percutaneous intervention, ventricular tachycardia/ventricular fibrillation, cardiogenic shock, death, internal cardioverter/ defibrillator placement, dissection extension) and follow-up (myocardial infarction, de novo SCAD, death, spontaneous superior mesenteric artery dissection) cardiac events were compared among those who were employed and those who were not. Results: The median age of patients in the study was 44 (37- 55) years. There were 42 (50.6%) female patients, and 41 (49.4) male patients. Of the cohort, 50 (60%) of the patients were employed and the remaining 33 (40%) were unemployed. 66% of all men were employed and 76% of all women were unemployed. After adjusting for gender unemployment was associated with worse in- -hospital and follow-up cardiac events (adjusted OR 7.1, [1.3, 37.9]), p = 0.021. Conclusion: Adverse cardiovascular events were significantly worse for patients with SCAD who were unemployed.

Diagnostic performance of waist-to-height ratio in identifying cardiovascular risk factors and metabolic syndrome among adult Saudis. A cross-sectional study