Clinical epidemiology of acute myocardial infarction in Kuwait

Objective - We studied the clinical epidemiological features of patients with AMI treated at a major hospital in Kuwait. The objectives of the study were to determine (i) personal and clinical characteristics of patients; (ii) prevalence of major risk factors among the patients; and (iii) factors associated with in-hospital morbidity and mortality. Methods and Results - All patients (n = 126) who fulfilled the standard diagnostic criteria for AMI and treated at the CCU of the study hospital during the calendar year 1996 were included in the study. Patients were identified from the CCU register and information was extracted from the medical records. Multiple logistic regression was performed to study the factors independently associated with in-hospital morbidity and mortality. Of the 126 patients, 84.9% were men and 15.1 % were women; and 40.5% were Kuwaiti nationals and 59.5% were expatriates. On average, male patients were younger than females (mean age = 52.4 +/- 10.4 years vs. 60.2 +/- 10.2 years), and male expatriates were the youngest sub-group in the study (mean age = 49.7 +/- 8.7 years). Overall, history of diabetes, hypertension, and CHD was recorded in 44.4%, 29.6%, and 16.8% of the patients, respectively. About 58% of the male patients were current smelters and the prevalence of smoking was significantly higher in expatriates compared with Kuwaiti patients (62% vs 36%, respectively), Kuwaiti nationals had a significantly high prevalence of diabetes compared with the expatriates (57% vs 36%, respectively). There was a significant trend in increasing prevalence of diabetes, hypertension and CHD with age whereas smoking was most prevalent (87%) in the youngest age group. As for the clinical features, 70.5% of the patients presented within 6 hours of the onset of symptoms, 73% presented with ST-segment elevation (40.5% with inferior, 32.5% with anterior ST-segment elevation), and fibrinolytic therapy was given to 63.6% of the patients. About half of the patients had an admission blood glucose level of greater than or equal to 10 mmol/l, and 70.6% had a fasting blood glucose level of greater than or equal to 6.1 mmol/l one day after admission, In the multiple logistic regression analysis, old age (> 60 years), anterior MI, and admission blood glucose level of greater than or equal to 10 mmol/l were found to be significantly associated with in-hospital cardiac morbidity. The in-hospital case fatality was about 6%, Old age and history of CHD were found to be the significant predictors of in-hospital mortality. Conclusion - Control of smelting and early diagnosis and appropriate treatment of diabetes may reduce the burden of AMI-related morbidity and mortality.