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Background: Risk stratification is an important step in proper management of acute coronary syndromes (ACS). This should be carried in every hospital as it might improve the outcome even in hospitals with no coronary angiogram facility but are following the guideline of management. Objective: We present the characterization based on thrombolysis in myocardial infarction (TIMI) risk profile of unstable angina (UA)/non-ST-segment elevation (NSTEMI) myocardial infarction - ACS in diabetic patients in King Abdulaziz Medical City National Guard Hospital (KAMC) in Jeddah, a noninvasive facility and compared with 4 other hospitals in the Kingdom of Saudi Arabia with cardiac catheterization facilities. These hospitals were involved in multicenter international diabetes-ACS study. In addition, we compared the characterization of two therapeutic modalities used in management of such cases: Glycoprotein (GP) IIb/IIIa inhibitors and coronary angiogram. Materials and Methods: The characterization of the risk profile of 35 diabetic patients from KAMC, noninvasive hospital were compared with 142 patients from four hospitals in KSA, and 3,624 patients from the international hospitals who had cardiac catheterization facility admitted with UA/NSTEMI, ACS. Results: The distributions of TIMI scores were similar among the three groups. The odds ratios were also comparable across the three groups. When GP IIb/IIIa inhibitors usages were compared, the usage for a particular group was not different. The high risk factors were similar in patients who underwent coronary angiogram in the centers of KSA who had cardiac catheterization in comparison to those international centers. Conclusions: The nonavailability of catheterization facilities does not cause referral bias, with risk factors being similar and treatment approach was matching. Immediate triage and risk stratification, e.g. TIMI score will affect the outcome of cardiovascular mortality and might explain some similarity in the outcome between invasive and noninvasive hospitals. |
