The Importance of the First Jordanian Percutaneous Coronary Intervention Registry.

In this issue of Heart Views, Alhaddad et al. report on The First Jordanian Percutaneous Coronary Intervention Registry 1 (JoPCR1).[1]

Heart disease remains the major cause of death worldwide. To date, most of the data about patients with cardiovascular diseases were reported from the developed countries. Although cardiovascular disease is the main cause of death in the Middle East, data about Middle Eastern patients with acute cardiac conditions are scarce.[2]

The Gulf Heart Association (GHA), a regional and professional cardiac society in the Middle East, located in the Gulf Cooperation Council (GCC) countries, has launched several multicenter, multinational registries for acute coronary syndrome (ACS),[34] atrial fibrillation,[5] and heart failure.[67] The Gulf Registry of Acute Coronary Events (Gulf RACE) (conducted in 2007 and included 8169 patients) and Gulf RACE-2 (conducted in 2009 and included 7939 patients) were on Middle Eastern patients and from the GCC states, namely, Bahrain, Saudi Arabia, Kuwait, Qatar, Oman, the United Arab Emirates, and Yemen.[3] Gulf RACE-2 had 1-year follow-up.[4]

The registries of Gulf RACE and Gulf RACE-2 provide valuable information to health-care officials. Overall, patients were younger when compared to registries from the developed countries and were more likely to be diabetic. The care provided was comparable to that of the developed countries; while other aspects were clearly suboptimal such as[1] underutilization of emergency medical services (EMS) – only 17% of patients in Gulf RACE presented to the emergency department by EMS,[62] the use of fibrinolytic therapy as the primary reperfusion modality for ST-elevation myocardial infarction (STEMI) patients, and[3] the underutilization of cardiac catheterization for patients admitted with ACS. Notwithstanding, the overall mortality rates were low and attributable in part to the younger age group and the high use of evidence-based medical therapy.[34] These findings have significant implications for improving care and outcome of ACS patients from Gulf countries.

The GHA subsequently conducted the Gulf CARE registry – first multicenter acute heart failure registry in the Middle East, which enrolled patients from 47 hospitals in 7 Middle Eastern countries.[56] The mean age of patients in this heart failure registry was a decade younger with a high prevalence of diabetes mellitus (DM) when compared to their Western counterparts, which is also consistent with the findings from Gulf RACE and Gulf RACE-2 registries.[34]

The first JoPCR1 reported in this edition[1] complements the previously reported cardiovascular registries from the Middle East. Furthermore, to the best of our knowledge, this is the first Percutaneous Coronary Intervention (PCI) registry from the region and is reported from a different Middle Eastern country (Jordan) when compared to previous reports (Bahrain, Kuwait, Qatar, the UAE, the KSA, Oman, and Yemen). Interestingly, the mean age (56 years) of patients in this registry and prevalence of DM (53%) are consistent with those reports from Gulf RACE, Gulf RACE-2, and Gulf CARE. The majority of patients in the JoPCR1 underwent PCI for ACS (77%) including 30% who had PCI for STEMI. Of those treated, 60% had one stent and 27% had two stents. The in-hospital and 1-year mortality rates are very low and consistent with the international standards (0.78% and 1.94%, respectively).

The current registry highlights the importance of conducting registries in various cardiovascular diseases in the Middle East to monitor and improve patients' outcomes. Finally, the impressive similarity between Middle Eastern patients with various cardiac diseases in regards to age and various cardiovascular risk factors suggests the urgent need to plan major cardiovascular registries that include patients from various Middle Eastern countries.