Characteristics and Treatment Pattern of Diabetic Patients with ACS: A Saudi Perspective from the MIDAS Registry

Journal of Clinical and Basic Cardiology 2013; 16 (1-4): 6-9

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Keywords: ACS,  GPIIb/IIIa,  MIDAS,  NSTEMI,  Saudi

Background: The Multicenter International Diabetes – Acute coronary Syndromes (MIDAS) study aimed to monitor the adherence to evidencebased therapy among diabetic patients (DM) with unstable angina or non-ST-segment elevation myocardial infarction (ACS) and to describe the in-hospital outcomes of DM in the setting of ACS. We present the data of the Kingdom of Saudi Arabia (KSA) based on the risk profile of the patients in comparison to the international registry. Design: Data of DM patients with ACS who presented at the time of admission to the emergency/coronary care units in 5 hospitals in KSA were extracted from the registry. A total of 3624 patients were enrolled in several countries in Europe, the Middle East, and India. The following variables were extracted: ST deviation ≥ 0.5 mm, positive troponin, and TIMI risk score. The Z test for 2 proportions was used to compare the KSA values with the international figures. Analysis was done using stata 10. Level of significance was set at 5 %. Results: “Type-2:type-1 DM ratio” in KSA was comparable to the international ratio (93.65 vs 93.83). The high risk factors were significantly less prevalent in KSA in comparison to the international figures (17 % showed significant ST deviation ≥ 0.5 mm vs 46 % [p = 0.005], 40 % showed positive troponin vs 70 % [p < 0.0001], and 32 % showed a TIMI risk score > 3 in comparison to 62 % [p < 0.0001]). Utilization of GPIIb/IIIa was 18.3 % in KSA vs 37.4 % internationally (p = 0.046). On the contrary, the utilization of clopidogrel/ticlopidine was 96.8 % in KSA vs 74.7 % internationally (p < 0.0001). The percentage of early coronary angiography was 38.9 % in KSA vs 46.1 % internationally (p = 0.292). Among patients who had early coronary angiography, 34.9 % had revascularization (PCI and/or CABG) in KSA in comparison to 54.8 % in the international samples (p = 0.199). Conclusions: Saudi DM patients with ACS had similar demographic data compared to international patients. There was a satisfactory use of evidence-based medicine in the treatment in such a group.