Sameh Shaheen | Arizona State University (original) (raw)

Papers by Sameh Shaheen

Research paper thumbnail of Endomyocardial biopsy: safety and prognostic utility in paediatric and adult myocarditis in the European Society of Cardiology EURObservational Research Programme Cardiomyopathy and Myocarditis Long-Term Registry

European heart journal, Apr 10, 2024

Research paper thumbnail of Cardiomyopathies in children and adolescents: aetiology, management, and outcomes in the European Society of Cardiology EURObservational Research Programme Cardiomyopathy and Myocarditis Registry

European heart journal, Mar 1, 2024

Research paper thumbnail of Fatal pulmonary embolism following injectable gluteal filler usage: a case report

The Egyptian Heart Journal, Oct 9, 2023

Research paper thumbnail of Care of patients with ST-elevation myocardial infarction: an international analysis of quality indicators in the acute coronary syndrome STEMI Registry of the EURObservational Research Programme and ACVC and EAPCI Associations of the European Society of Cardiology in 11 462 patients

European heart journal. Acute cardiovascular care, Nov 8, 2022

Aims To use quality indicators to study the management of ST-segment elevation myocardial infarct... more Aims To use quality indicators to study the management of ST-segment elevation myocardial infarction (STEMI) in different regions. Methods and results Prospective cohort study of STEMI within 24 h of symptom onset (11 462 patients, 196 centres, 26 European Society of Cardiology members, and 3 affiliated countries). The median delay between arrival at a percutaneous cardiovascular intervention (PCI) centre and primary PCI was 40 min (interquartile range 20–74) with 65.8% receiving PCI within guideline recommendation of 60 min. A third of patients (33.2%) required transfer from their initial hospital to one that could perform emergency PCI for whom only 27.2% were treated within the quality indicator recommendation of 120 min. Radial access was used in 56.6% of all primary PCI, but with large geographic variation, from 76.4 to 9.1%. Statins were prescribed at discharge to 98.7% of patients, with little geographic variation. Of patients with a history of heart failure or a documented left ventricular ejection fraction ≤40%, 84.0% were discharged on an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and 88.7% were discharged on beta-blockers. Conclusion Care for STEMI shows wide geographic variation in the receipt of timely primary PCI, and is in contrast with the more uniform delivery of guideline-recommended pharmacotherapies at time of hospital discharge.

Research paper thumbnail of Prevalance of aspirin resistance and its impact on angiographic and clinical outcomes post–elective percutaneous coronary intervention

Cardiovascular Revascularization Medicine, Apr 1, 2008

Research paper thumbnail of Care of patients with ST-elevation myocardial infarction: an international analysis of quality indicators in the acute coronary syndrome STEMI Registry of the EURObservational Research Programme and ACVC and EAPCI Associations of the European Society of Cardiology in 11 462 patients

European Heart Journal. Acute Cardiovascular Care

Aims To use quality indicators to study the management of ST-segment elevation myocardial infarct... more Aims To use quality indicators to study the management of ST-segment elevation myocardial infarction (STEMI) in different regions. Methods and results Prospective cohort study of STEMI within 24 h of symptom onset (11 462 patients, 196 centres, 26 European Society of Cardiology members, and 3 affiliated countries). The median delay between arrival at a percutaneous cardiovascular intervention (PCI) centre and primary PCI was 40 min (interquartile range 20–74) with 65.8% receiving PCI within guideline recommendation of 60 min. A third of patients (33.2%) required transfer from their initial hospital to one that could perform emergency PCI for whom only 27.2% were treated within the quality indicator recommendation of 120 min. Radial access was used in 56.6% of all primary PCI, but with large geographic variation, from 76.4 to 9.1%. Statins were prescribed at discharge to 98.7% of patients, with little geographic variation. Of patients with a history of heart failure or a documented l...

Research paper thumbnail of Implementation of a Regional STEMI Network in North Cairo (Egypt): Impact on The Management and Outcome of STEMI Patients

Research paper thumbnail of P4627Presentation, management, and outcomes of STEMI in Egypt: results from the European Society of Cardiology registry on ST elevation myocardial infarction

European Heart Journal, 2019

Background Apart from few small single-center studies there are limited data about STEMI patients... more Background Apart from few small single-center studies there are limited data about STEMI patients in Egypt. Patients and methods The European Society of Cardiology (ESC) Registry on ST Elevation Myocardial Infarction is a prospective, multicenter and observational registry. Nineteen Egyptian centers (with and without PCI facilities) participated in this registry with 1356 patients who were compared to 7420 patients from other ESC countries. Patient recruitment started from March 2016 to February 2018. Aims of the study The aims of this study was to describe the characteristics of patients with STEMI, to assess STEMI management patterns, to evaluate in-hospital patient outcome and to compare Egyptian patients with other ESC countries. Results Compared to other ESC countries, Egyptian patients were younger (mean age 55.4±11.3 vs. 62.9±12.4; P<0.001 and 4.3% vs. 19.4%% were ≥75 years old; P<0.001) with fewer females (18.4% vs. 25.6%; P<0.001). Fewer Egyptian patients had histo...

Research paper thumbnail of Percutaneous coronary artery intervention in unprotected left main coronary artery disease: one-year outcome Egyptian registry

The Egyptian Heart Journal, Sep 6, 2022

Background: Left main coronary artery lesions are associated with jeopardy of an outsized area of... more Background: Left main coronary artery lesions are associated with jeopardy of an outsized area of the myocardium, causing a high incidence of morbidity and mortality. Optimal treatment of coronary bifurcation anatomy remains highly debatable, whether by provisional or two-stent technique. This prospective observational study was designed to investigate the one-year clinical outcomes of unprotected left main coronary artery disease revascularization by percutaneous coronary intervention in a "real-world" setting among Egyptian patients in a prospective single-center registry (at Ain Shams University Hospitals). Results: This study included 163 patients who underwent PCI to LM lesions between May 1, 2020, and the end of April in Ain Shams University hospitals. Patients were dichotomized into two groups according to their intended stenting technique, whether provisional or two-stent technique. A total of 142 underwent provisional stenting while 21 were designated for the two-stent technique, mainly DK crush (double kissing). Among the patients with intended provisional stenting, 34 patients underwent the TAP technique. Patients were followed up for the primary endpoints, at the in-hospital setting, at 30 days, and after 1 year. In-hospital death was encountered in 6.34% of cases undergoing provisional stenting, among which 5.36% were due to a cardiovascular cause. Total MACCE was found to be 2.96% in the provisional stenting group versus 4.76% in the two-stent group. Overall, MACCE at 1 year was found to be 22.31% in the provisional group and 30% in the two-stent group (p-value0.57). TVF was recognized in 10% of cases treated by provisional stenting and 30% of cases treated by the two-stent technique (p-value 0.023). Conclusions: LM coronary artery lesions treatment by PCI is considered a safe and beneficial solution. Provisional stenting is the preferred approach bearing in mind that bail-out procedures may be sought in case the SB needs further treatment. Adjunctive assessment by IVUS or FFR may help achieve better outcomes, and efforts should be performed to facilitate their feasibility.

Research paper thumbnail of The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry

European Heart Journal - Quality of Care and Clinical Outcomes, 2019

Aims The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Int... more Aims The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI. Methods and results Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristic...

Research paper thumbnail of Egyptian expert opinion for the use of sodium‐glucose cotransporter‐2 inhibitors in patients with heart failure with reduced ejection fraction

ESC Heart Failure, 2022

Sodium-glucose cotransporter-2 inhibitor (SGLT2i) in patients with type 2 diabetes reduces the ri... more Sodium-glucose cotransporter-2 inhibitor (SGLT2i) in patients with type 2 diabetes reduces the risk of serious heart failure events, specifically the risk of hospitalization for heart failure, and cardiovascular death. The benefit is most apparent in patients with a heart failure with reduced ejection fraction (HFrEF). Dapagliflozin and empagliflozin reduced the risk of cardiovascular death and hospitalizations for heart failure in patients with established HFrEF, including those without diabetes. Considering the magnitude of the problem and the expected benefit on the target population, an Egyptian consensus document was conducted to demonstrate the importance of and the critical knowledge needed for effective and safe implementation of SGLT2i in the daily practice for the management of patients with HFrEF.

Research paper thumbnail of Barriers to the Implementation of Primary PCI in the Management of STEMI in Egypt

Cardiovascular Innovations and Applications, 2021

Introduction: Evidence-based guidelines recommend primary percutaneous coronary intervention (PPC... more Introduction: Evidence-based guidelines recommend primary percutaneous coronary intervention (PPCI) be the mainstay reperfusion strategy for the treatment of ST-segment elevation myocardial infarction (STEMI) if it is performedin the proper time window. However, the Egyptian health care system is still struggling to provide such an important service. The aim of the present study, through a quantitative questionnaire, is to explore the current practice of STEMI management in Egypt, and to identify the barriers, opportunities, and potential areas for improvement.Methods and Results: The questionnaire was conducted in Egypt via face-to-face qualitative in-depth interviews with cardiologists from 14 PPCI-capable hospitals and 26 non-PPCI-capable hospitals. Participants were selected in view of their experience and knowledge. The study identified potential barriers to the implementation of PPCI among STEMI patients in Egypt. These barriers included the prehospital patient delay and emerg...

Research paper thumbnail of Brand versus Generic Rosuvastatin in Egyptian Patients with Hyperlipidemia; Cost-Minimization Analysis

International Journal of Clinical Medicine

Background: Serum level of cholesterol is one of the most vital risk factors for cardiovascular d... more Background: Serum level of cholesterol is one of the most vital risk factors for cardiovascular diseases (CVD). Statins are highly effective drugs for reducing serum cholesterol; hence, preventing coronary heart disease (CHD). Rosuvastatin (Crestor) is one of the most potent and widely prescribed statins. Even though generic statins have been approved based on their bioequivalence with brand-name drugs, there remains considerable concern as regards their effectiveness and safety. Most clinicians and patients welcome the generic drug decreased costs; however, it is indispensable for them that effectiveness and safety are not compromised. Thus, the rationale intended for this study is to compare brand rosuvastatin and generic rosuvastatin as regard their economic impact using a cost-minimization analysis. Methods: This cost-minimization model estimates potential impact of rosuvastatin brand versus generic on the healthcare resource utilization for one-year frame from the payer perspective. The model conforms to real practice of management of hyperlipidemia in Egypt and was validated by experts. Results: The drug costs in the rosuvastatin brand group were 3,155,250 EGP while in the generic group were 2,299,030 EGP. The costs of CVD events in the rosuvastatin brand group were 5,863,558 EGP, while in the generic group were 6,810,180 EGP. The total costs in the rosuvastatin brand group were 9,018,808 EGP, while in the generic group were 9,109,210 EGP with a difference of −100,047 EGP. Conclusions: In conclusion, the real cost of generic treatment is more than that of the brand statin when taking into consideration the cardiovascular events.

Research paper thumbnail of 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation

European Heart Journal, 2017

Research paper thumbnail of National Heart Institute Acute Coronary Syndrome Registry

Objective: Acute coronary syndromes (ACS) represent the acute life threatening phase of coronary ... more Objective: Acute coronary syndromes (ACS) represent the acute life threatening phase of coronary artery disease [1] , registries and surveys have the potential to define the 'gaps' between evidence and practice as well as implementation of guidelines [2] . Aim of the Work: To assess the application of a newly designed registry among Egyptian patients with ACS and to compare the results with those of other international registries. Methods: The study included 401 patients having acute coronary syndrome admitted to the National Heart Institute CCU over 6 months from January 2007 to June 2007 that were subjected to full history & clinical examination, 12 leads, ECG, and echocardiography. Patients were classified according to the ECG at presentation into ACS with ST elevation, ACS Abbreviations: ACS = Acute Coronary Syndrome NHI = National Heart Institute HTN = Hypertension DM = Diabetes Mellitus ER = Emergency Room MI = Myocardial infraction CABG = Coronary artery Bypass Graft....

Research paper thumbnail of The Effect of Sacubitril/Valsartan on Functional Capacity of Patients Diagnosed With Heart Failure With Reduced Ejection Fraction Assessed by Six Minute Walk Test

Background: Heart failure (HF) constitutes a leading cause of morbidity and mortality worldwide a... more Background: Heart failure (HF) constitutes a leading cause of morbidity and mortality worldwide and is associated with severe impairment in functional capacity. In patients with chronic HF and reduced ejection fraction (HFrEF), the PARADIGM-HF (Prospective Comparison of ARNI with an ACE-Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial showed that sacubitril/valsartan reduced the risk of the composite of cardiovascular (CV) death or first hospitalization for heart failure (HF) by 20% compared to enalapril during a median follow-up of 27 months. Remarkably, the trial showed also an early beneficial effect of sacubitril/valsartan by reducing the risk of 30-day readmission for any cause and HF by 26% and 38%, respectively. However, there is limited data on the short-term effect of sacubitril/valsartan on patient's functional performance. Objective: To evaluate if there is any short term effect of Sacubitril/Valarstan drug on the functional capa...

Research paper thumbnail of The relation between platelet/lymphocyte ratio and the occurrence of no reflow in patients with ST-segment elevation myocardial infarction managed by primary percutaneous coronary intervention

International Journal of the Cardiovascular Academy

Introduction: No reflow phenomenon following primary percutaneous coronary intervention (PCI) is ... more Introduction: No reflow phenomenon following primary percutaneous coronary intervention (PCI) is a strong predictor of mortality. Platelet/lymphocyte ratio (PLR) is an indicator of long-term outcome in ischemic heart disease patients. The aim of this study was to assess the relation between PLR measured on admission and the occurrence of no-reflow phenomenon in patients presenting with acute ST-segment elevation myocardial infarction (STEMI) managed by primary PCI. Methods: This was a prospective study including 100 patients with acute STEMI managed by primary PCI. Venous blood samples were obtained on admission to assess hemoglobin level, platelet count, and lymphocyte count. Thrombolysis in myocardial infarction (TIMI) flow grade, myocardial blush grade (MBG), and TIMI thrombus scale were assessed immediately following revascularization. During hospital stay, peak creatinine kinase MB fraction (CK-MB) was recorded, and transthoracic echocardiography was performed to assess left ventricular ejection fraction (LVEF). Results: Patients were divided into two groups based on the TIMI flow grade following PCI: Normal coronary flow group (TIMI 3 flow grade, n = 71) and reduced coronary flow (no-reflow) group (TIMI 0, 1, and 2, n = 29). There was a larger proportion of diabetic patients in the no-reflow group (P = 0.028). In addition, patients in the no-reflow group had a more advanced Killip class on presentation (P = 0.001), a lower LVEF (P < 0.0001), and a significantly higher PLR 213.66 ± 115.35 versus 122.81 ± 59.82 (P < 0.0001). PLR was significantly higher in patients with lower TIMI flow grade and lower MBG (P < 0.0001 for both). A significant correlation existed generally between PLR and peak CK-MB more in the no-reflow group (r = 0.471, P = 0.01). A PLR more than 108.08 predicted no-reflow with a sensitivity of 53%, a specificity of 86%, PPV of 80.%, and a NPV of 43.1% (AUC = 0.73). PLR was found to be an independent predictor of no-reflow multivariate regression analysis for predictors of no-reflow (ß = 0.0023, 9% CI = 0.0014–0.0032, P < 0.0001). Conclusions: PLR measured on admission is elevated in patients with STEMI who develop no-reflow during primary PCI. PLR is an independent predictor of no-reflow in such patients.

Research paper thumbnail of The Correlation Between Symptoms Severity of Left Ventricular Systolic Heart Failure and Tissue Doppler Indices

Journal of Cardiology & Current Research

There are two types of heart failure patient's exercise performance methods: subjective and objec... more There are two types of heart failure patient's exercise performance methods: subjective and objective. The subjective methods include NYHA classification, various activity scales, and quality of life specific questionnaires. The objective methods include various modes of exercise testing to document submaximal exercise capacity (6-minute corridor walk test and anaerobic threshold analysis), as well as maximal exercise capacity (exercise time and maximal oxygen consumption measurement) [2]. A variety of noninvasive imaging modalities are available for assessment of patients with heart failure. These include echocardiography, TDI, radionuclide imaging, and cardiovascular magnetic resonance imaging (CMRI), without any correlation to symptoms severity of left ventricular systolic

Research paper thumbnail of Reperfusion therapies and in-hospital outcomes for ST-elevation myocardial infarction in Europe: the ACVC-EAPCI EORP STEMI Registry of the European Society of Cardiology

European Heart Journal

Aims The aim of this study was to determine the contemporary use of reperfusion therapy in the E... more Aims The aim of this study was to determine the contemporary use of reperfusion therapy in the European Society of Cardiology (ESC) member and affiliated countries and adherence to ESC clinical practice guidelines in patients with ST-elevation myocardial infarction (STEMI). Methods and results Prospective cohort (EURObservational Research Programme STEMI Registry) of hospitalized STEMI patients with symptom onset <24 h in 196 centres across 29 countries. A total of 11 462 patients were enrolled, for whom primary percutaneous coronary intervention (PCI) (total cohort frequency: 72.2%, country frequency range 0–100%), fibrinolysis (18.8%; 0–100%), and no reperfusion therapy (9.0%; 0–75%) were performed. Corresponding in-hospital mortality rates from any cause were 3.1%, 4.4%, and 14.1% and overall mortality was 4.4% (country range 2.5–5.9%). Achievement of quality indicators for reperfusion was reported for 92.7% (region range 84.8–97.5%) for the performance of reperfusion therap...

Research paper thumbnail of Practical perspectives on the use of non-vitamin K antagonist oral anticoagulants for stroke prevention in patients with nonvalvular atrial fibrillation: A view from the Middle East and North Africa

Journal of the Saudi Heart Association, 2018

Clinical guidelines for the prevention of stroke in patients with nonvalvular atrial fibrillation... more Clinical guidelines for the prevention of stroke in patients with nonvalvular atrial fibrillation (NVAF) are available from several international cardiology associations. Patients with NVAF in the Middle East and North Africa (MENA) region present unique challenges and opportunities related to differences in geography, practice patterns, and patient demographics that are as yet unaddressed in practice guidelines. This review aims to offer a practical perspective on the management of NVAF in patients in MENA and draws on evidence-based guidelines as well as real-world evidence and expert opinion. The literature was searched for relevant original research articles, systematic reviews, meta-analyses, and guideline recommendations addressing the prevention of stroke in patients with NVAF with a focus on issues relevant to the MENA region. Guideline recommendations, best practices, and expert opinion were discussed and agreed on by a working group consisting of cardiologists from across ...

Research paper thumbnail of Endomyocardial biopsy: safety and prognostic utility in paediatric and adult myocarditis in the European Society of Cardiology EURObservational Research Programme Cardiomyopathy and Myocarditis Long-Term Registry

European heart journal, Apr 10, 2024

Research paper thumbnail of Cardiomyopathies in children and adolescents: aetiology, management, and outcomes in the European Society of Cardiology EURObservational Research Programme Cardiomyopathy and Myocarditis Registry

European heart journal, Mar 1, 2024

Research paper thumbnail of Fatal pulmonary embolism following injectable gluteal filler usage: a case report

The Egyptian Heart Journal, Oct 9, 2023

Research paper thumbnail of Care of patients with ST-elevation myocardial infarction: an international analysis of quality indicators in the acute coronary syndrome STEMI Registry of the EURObservational Research Programme and ACVC and EAPCI Associations of the European Society of Cardiology in 11 462 patients

European heart journal. Acute cardiovascular care, Nov 8, 2022

Aims To use quality indicators to study the management of ST-segment elevation myocardial infarct... more Aims To use quality indicators to study the management of ST-segment elevation myocardial infarction (STEMI) in different regions. Methods and results Prospective cohort study of STEMI within 24 h of symptom onset (11 462 patients, 196 centres, 26 European Society of Cardiology members, and 3 affiliated countries). The median delay between arrival at a percutaneous cardiovascular intervention (PCI) centre and primary PCI was 40 min (interquartile range 20–74) with 65.8% receiving PCI within guideline recommendation of 60 min. A third of patients (33.2%) required transfer from their initial hospital to one that could perform emergency PCI for whom only 27.2% were treated within the quality indicator recommendation of 120 min. Radial access was used in 56.6% of all primary PCI, but with large geographic variation, from 76.4 to 9.1%. Statins were prescribed at discharge to 98.7% of patients, with little geographic variation. Of patients with a history of heart failure or a documented left ventricular ejection fraction ≤40%, 84.0% were discharged on an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and 88.7% were discharged on beta-blockers. Conclusion Care for STEMI shows wide geographic variation in the receipt of timely primary PCI, and is in contrast with the more uniform delivery of guideline-recommended pharmacotherapies at time of hospital discharge.

Research paper thumbnail of Prevalance of aspirin resistance and its impact on angiographic and clinical outcomes post–elective percutaneous coronary intervention

Cardiovascular Revascularization Medicine, Apr 1, 2008

Research paper thumbnail of Care of patients with ST-elevation myocardial infarction: an international analysis of quality indicators in the acute coronary syndrome STEMI Registry of the EURObservational Research Programme and ACVC and EAPCI Associations of the European Society of Cardiology in 11 462 patients

European Heart Journal. Acute Cardiovascular Care

Aims To use quality indicators to study the management of ST-segment elevation myocardial infarct... more Aims To use quality indicators to study the management of ST-segment elevation myocardial infarction (STEMI) in different regions. Methods and results Prospective cohort study of STEMI within 24 h of symptom onset (11 462 patients, 196 centres, 26 European Society of Cardiology members, and 3 affiliated countries). The median delay between arrival at a percutaneous cardiovascular intervention (PCI) centre and primary PCI was 40 min (interquartile range 20–74) with 65.8% receiving PCI within guideline recommendation of 60 min. A third of patients (33.2%) required transfer from their initial hospital to one that could perform emergency PCI for whom only 27.2% were treated within the quality indicator recommendation of 120 min. Radial access was used in 56.6% of all primary PCI, but with large geographic variation, from 76.4 to 9.1%. Statins were prescribed at discharge to 98.7% of patients, with little geographic variation. Of patients with a history of heart failure or a documented l...

Research paper thumbnail of Implementation of a Regional STEMI Network in North Cairo (Egypt): Impact on The Management and Outcome of STEMI Patients

Research paper thumbnail of P4627Presentation, management, and outcomes of STEMI in Egypt: results from the European Society of Cardiology registry on ST elevation myocardial infarction

European Heart Journal, 2019

Background Apart from few small single-center studies there are limited data about STEMI patients... more Background Apart from few small single-center studies there are limited data about STEMI patients in Egypt. Patients and methods The European Society of Cardiology (ESC) Registry on ST Elevation Myocardial Infarction is a prospective, multicenter and observational registry. Nineteen Egyptian centers (with and without PCI facilities) participated in this registry with 1356 patients who were compared to 7420 patients from other ESC countries. Patient recruitment started from March 2016 to February 2018. Aims of the study The aims of this study was to describe the characteristics of patients with STEMI, to assess STEMI management patterns, to evaluate in-hospital patient outcome and to compare Egyptian patients with other ESC countries. Results Compared to other ESC countries, Egyptian patients were younger (mean age 55.4±11.3 vs. 62.9±12.4; P<0.001 and 4.3% vs. 19.4%% were ≥75 years old; P<0.001) with fewer females (18.4% vs. 25.6%; P<0.001). Fewer Egyptian patients had histo...

Research paper thumbnail of Percutaneous coronary artery intervention in unprotected left main coronary artery disease: one-year outcome Egyptian registry

The Egyptian Heart Journal, Sep 6, 2022

Background: Left main coronary artery lesions are associated with jeopardy of an outsized area of... more Background: Left main coronary artery lesions are associated with jeopardy of an outsized area of the myocardium, causing a high incidence of morbidity and mortality. Optimal treatment of coronary bifurcation anatomy remains highly debatable, whether by provisional or two-stent technique. This prospective observational study was designed to investigate the one-year clinical outcomes of unprotected left main coronary artery disease revascularization by percutaneous coronary intervention in a "real-world" setting among Egyptian patients in a prospective single-center registry (at Ain Shams University Hospitals). Results: This study included 163 patients who underwent PCI to LM lesions between May 1, 2020, and the end of April in Ain Shams University hospitals. Patients were dichotomized into two groups according to their intended stenting technique, whether provisional or two-stent technique. A total of 142 underwent provisional stenting while 21 were designated for the two-stent technique, mainly DK crush (double kissing). Among the patients with intended provisional stenting, 34 patients underwent the TAP technique. Patients were followed up for the primary endpoints, at the in-hospital setting, at 30 days, and after 1 year. In-hospital death was encountered in 6.34% of cases undergoing provisional stenting, among which 5.36% were due to a cardiovascular cause. Total MACCE was found to be 2.96% in the provisional stenting group versus 4.76% in the two-stent group. Overall, MACCE at 1 year was found to be 22.31% in the provisional group and 30% in the two-stent group (p-value0.57). TVF was recognized in 10% of cases treated by provisional stenting and 30% of cases treated by the two-stent technique (p-value 0.023). Conclusions: LM coronary artery lesions treatment by PCI is considered a safe and beneficial solution. Provisional stenting is the preferred approach bearing in mind that bail-out procedures may be sought in case the SB needs further treatment. Adjunctive assessment by IVUS or FFR may help achieve better outcomes, and efforts should be performed to facilitate their feasibility.

Research paper thumbnail of The ESC ACCA EAPCI EORP acute coronary syndrome ST-elevation myocardial infarction registry

European Heart Journal - Quality of Care and Clinical Outcomes, 2019

Aims The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Int... more Aims The Acute Cardiac Care Association (ACCA)–European Association of Percutaneous Coronary Intervention (EAPCI) Registry on ST-elevation myocardial infarction (STEMI) of the EurObservational programme (EORP) of the European Society of Cardiology (ESC) registry aimed to determine the current state of the use of reperfusion therapy in ESC member and ESC affiliated countries and the adherence to ESC STEMI guidelines in patients with STEMI. Methods and results Between 1 January 2015 and 31 March 2018, a total of 11 462 patients admitted with an initial diagnosis of STEMI according to the 2012 ESC STEMI guidelines were enrolled. Individual patient data were collected across 196 centres and 29 countries. Among the centres, there were 136 percutaneous coronary intervention centres and 91 with cardiac surgery on-site. The majority of centres (129/196) were part of a STEMI network. The main objective of this study was to describe the demographic, clinical, and angiographic characteristic...

Research paper thumbnail of Egyptian expert opinion for the use of sodium‐glucose cotransporter‐2 inhibitors in patients with heart failure with reduced ejection fraction

ESC Heart Failure, 2022

Sodium-glucose cotransporter-2 inhibitor (SGLT2i) in patients with type 2 diabetes reduces the ri... more Sodium-glucose cotransporter-2 inhibitor (SGLT2i) in patients with type 2 diabetes reduces the risk of serious heart failure events, specifically the risk of hospitalization for heart failure, and cardiovascular death. The benefit is most apparent in patients with a heart failure with reduced ejection fraction (HFrEF). Dapagliflozin and empagliflozin reduced the risk of cardiovascular death and hospitalizations for heart failure in patients with established HFrEF, including those without diabetes. Considering the magnitude of the problem and the expected benefit on the target population, an Egyptian consensus document was conducted to demonstrate the importance of and the critical knowledge needed for effective and safe implementation of SGLT2i in the daily practice for the management of patients with HFrEF.

Research paper thumbnail of Barriers to the Implementation of Primary PCI in the Management of STEMI in Egypt

Cardiovascular Innovations and Applications, 2021

Introduction: Evidence-based guidelines recommend primary percutaneous coronary intervention (PPC... more Introduction: Evidence-based guidelines recommend primary percutaneous coronary intervention (PPCI) be the mainstay reperfusion strategy for the treatment of ST-segment elevation myocardial infarction (STEMI) if it is performedin the proper time window. However, the Egyptian health care system is still struggling to provide such an important service. The aim of the present study, through a quantitative questionnaire, is to explore the current practice of STEMI management in Egypt, and to identify the barriers, opportunities, and potential areas for improvement.Methods and Results: The questionnaire was conducted in Egypt via face-to-face qualitative in-depth interviews with cardiologists from 14 PPCI-capable hospitals and 26 non-PPCI-capable hospitals. Participants were selected in view of their experience and knowledge. The study identified potential barriers to the implementation of PPCI among STEMI patients in Egypt. These barriers included the prehospital patient delay and emerg...

Research paper thumbnail of Brand versus Generic Rosuvastatin in Egyptian Patients with Hyperlipidemia; Cost-Minimization Analysis

International Journal of Clinical Medicine

Background: Serum level of cholesterol is one of the most vital risk factors for cardiovascular d... more Background: Serum level of cholesterol is one of the most vital risk factors for cardiovascular diseases (CVD). Statins are highly effective drugs for reducing serum cholesterol; hence, preventing coronary heart disease (CHD). Rosuvastatin (Crestor) is one of the most potent and widely prescribed statins. Even though generic statins have been approved based on their bioequivalence with brand-name drugs, there remains considerable concern as regards their effectiveness and safety. Most clinicians and patients welcome the generic drug decreased costs; however, it is indispensable for them that effectiveness and safety are not compromised. Thus, the rationale intended for this study is to compare brand rosuvastatin and generic rosuvastatin as regard their economic impact using a cost-minimization analysis. Methods: This cost-minimization model estimates potential impact of rosuvastatin brand versus generic on the healthcare resource utilization for one-year frame from the payer perspective. The model conforms to real practice of management of hyperlipidemia in Egypt and was validated by experts. Results: The drug costs in the rosuvastatin brand group were 3,155,250 EGP while in the generic group were 2,299,030 EGP. The costs of CVD events in the rosuvastatin brand group were 5,863,558 EGP, while in the generic group were 6,810,180 EGP. The total costs in the rosuvastatin brand group were 9,018,808 EGP, while in the generic group were 9,109,210 EGP with a difference of −100,047 EGP. Conclusions: In conclusion, the real cost of generic treatment is more than that of the brand statin when taking into consideration the cardiovascular events.

Research paper thumbnail of 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation

European Heart Journal, 2017

Research paper thumbnail of National Heart Institute Acute Coronary Syndrome Registry

Objective: Acute coronary syndromes (ACS) represent the acute life threatening phase of coronary ... more Objective: Acute coronary syndromes (ACS) represent the acute life threatening phase of coronary artery disease [1] , registries and surveys have the potential to define the 'gaps' between evidence and practice as well as implementation of guidelines [2] . Aim of the Work: To assess the application of a newly designed registry among Egyptian patients with ACS and to compare the results with those of other international registries. Methods: The study included 401 patients having acute coronary syndrome admitted to the National Heart Institute CCU over 6 months from January 2007 to June 2007 that were subjected to full history & clinical examination, 12 leads, ECG, and echocardiography. Patients were classified according to the ECG at presentation into ACS with ST elevation, ACS Abbreviations: ACS = Acute Coronary Syndrome NHI = National Heart Institute HTN = Hypertension DM = Diabetes Mellitus ER = Emergency Room MI = Myocardial infraction CABG = Coronary artery Bypass Graft....

Research paper thumbnail of The Effect of Sacubitril/Valsartan on Functional Capacity of Patients Diagnosed With Heart Failure With Reduced Ejection Fraction Assessed by Six Minute Walk Test

Background: Heart failure (HF) constitutes a leading cause of morbidity and mortality worldwide a... more Background: Heart failure (HF) constitutes a leading cause of morbidity and mortality worldwide and is associated with severe impairment in functional capacity. In patients with chronic HF and reduced ejection fraction (HFrEF), the PARADIGM-HF (Prospective Comparison of ARNI with an ACE-Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial showed that sacubitril/valsartan reduced the risk of the composite of cardiovascular (CV) death or first hospitalization for heart failure (HF) by 20% compared to enalapril during a median follow-up of 27 months. Remarkably, the trial showed also an early beneficial effect of sacubitril/valsartan by reducing the risk of 30-day readmission for any cause and HF by 26% and 38%, respectively. However, there is limited data on the short-term effect of sacubitril/valsartan on patient's functional performance. Objective: To evaluate if there is any short term effect of Sacubitril/Valarstan drug on the functional capa...

Research paper thumbnail of The relation between platelet/lymphocyte ratio and the occurrence of no reflow in patients with ST-segment elevation myocardial infarction managed by primary percutaneous coronary intervention

International Journal of the Cardiovascular Academy

Introduction: No reflow phenomenon following primary percutaneous coronary intervention (PCI) is ... more Introduction: No reflow phenomenon following primary percutaneous coronary intervention (PCI) is a strong predictor of mortality. Platelet/lymphocyte ratio (PLR) is an indicator of long-term outcome in ischemic heart disease patients. The aim of this study was to assess the relation between PLR measured on admission and the occurrence of no-reflow phenomenon in patients presenting with acute ST-segment elevation myocardial infarction (STEMI) managed by primary PCI. Methods: This was a prospective study including 100 patients with acute STEMI managed by primary PCI. Venous blood samples were obtained on admission to assess hemoglobin level, platelet count, and lymphocyte count. Thrombolysis in myocardial infarction (TIMI) flow grade, myocardial blush grade (MBG), and TIMI thrombus scale were assessed immediately following revascularization. During hospital stay, peak creatinine kinase MB fraction (CK-MB) was recorded, and transthoracic echocardiography was performed to assess left ventricular ejection fraction (LVEF). Results: Patients were divided into two groups based on the TIMI flow grade following PCI: Normal coronary flow group (TIMI 3 flow grade, n = 71) and reduced coronary flow (no-reflow) group (TIMI 0, 1, and 2, n = 29). There was a larger proportion of diabetic patients in the no-reflow group (P = 0.028). In addition, patients in the no-reflow group had a more advanced Killip class on presentation (P = 0.001), a lower LVEF (P < 0.0001), and a significantly higher PLR 213.66 ± 115.35 versus 122.81 ± 59.82 (P < 0.0001). PLR was significantly higher in patients with lower TIMI flow grade and lower MBG (P < 0.0001 for both). A significant correlation existed generally between PLR and peak CK-MB more in the no-reflow group (r = 0.471, P = 0.01). A PLR more than 108.08 predicted no-reflow with a sensitivity of 53%, a specificity of 86%, PPV of 80.%, and a NPV of 43.1% (AUC = 0.73). PLR was found to be an independent predictor of no-reflow multivariate regression analysis for predictors of no-reflow (ß = 0.0023, 9% CI = 0.0014–0.0032, P < 0.0001). Conclusions: PLR measured on admission is elevated in patients with STEMI who develop no-reflow during primary PCI. PLR is an independent predictor of no-reflow in such patients.

Research paper thumbnail of The Correlation Between Symptoms Severity of Left Ventricular Systolic Heart Failure and Tissue Doppler Indices

Journal of Cardiology & Current Research

There are two types of heart failure patient's exercise performance methods: subjective and objec... more There are two types of heart failure patient's exercise performance methods: subjective and objective. The subjective methods include NYHA classification, various activity scales, and quality of life specific questionnaires. The objective methods include various modes of exercise testing to document submaximal exercise capacity (6-minute corridor walk test and anaerobic threshold analysis), as well as maximal exercise capacity (exercise time and maximal oxygen consumption measurement) [2]. A variety of noninvasive imaging modalities are available for assessment of patients with heart failure. These include echocardiography, TDI, radionuclide imaging, and cardiovascular magnetic resonance imaging (CMRI), without any correlation to symptoms severity of left ventricular systolic

Research paper thumbnail of Reperfusion therapies and in-hospital outcomes for ST-elevation myocardial infarction in Europe: the ACVC-EAPCI EORP STEMI Registry of the European Society of Cardiology

European Heart Journal

Aims The aim of this study was to determine the contemporary use of reperfusion therapy in the E... more Aims The aim of this study was to determine the contemporary use of reperfusion therapy in the European Society of Cardiology (ESC) member and affiliated countries and adherence to ESC clinical practice guidelines in patients with ST-elevation myocardial infarction (STEMI). Methods and results Prospective cohort (EURObservational Research Programme STEMI Registry) of hospitalized STEMI patients with symptom onset <24 h in 196 centres across 29 countries. A total of 11 462 patients were enrolled, for whom primary percutaneous coronary intervention (PCI) (total cohort frequency: 72.2%, country frequency range 0–100%), fibrinolysis (18.8%; 0–100%), and no reperfusion therapy (9.0%; 0–75%) were performed. Corresponding in-hospital mortality rates from any cause were 3.1%, 4.4%, and 14.1% and overall mortality was 4.4% (country range 2.5–5.9%). Achievement of quality indicators for reperfusion was reported for 92.7% (region range 84.8–97.5%) for the performance of reperfusion therap...

Research paper thumbnail of Practical perspectives on the use of non-vitamin K antagonist oral anticoagulants for stroke prevention in patients with nonvalvular atrial fibrillation: A view from the Middle East and North Africa

Journal of the Saudi Heart Association, 2018

Clinical guidelines for the prevention of stroke in patients with nonvalvular atrial fibrillation... more Clinical guidelines for the prevention of stroke in patients with nonvalvular atrial fibrillation (NVAF) are available from several international cardiology associations. Patients with NVAF in the Middle East and North Africa (MENA) region present unique challenges and opportunities related to differences in geography, practice patterns, and patient demographics that are as yet unaddressed in practice guidelines. This review aims to offer a practical perspective on the management of NVAF in patients in MENA and draws on evidence-based guidelines as well as real-world evidence and expert opinion. The literature was searched for relevant original research articles, systematic reviews, meta-analyses, and guideline recommendations addressing the prevention of stroke in patients with NVAF with a focus on issues relevant to the MENA region. Guideline recommendations, best practices, and expert opinion were discussed and agreed on by a working group consisting of cardiologists from across ...

Research paper thumbnail of NILE Registry (National Heart Institute Large Egyptian): Registry of Cardiac Catheterization and Angioplasty Before the 2011 Revoltion

The Society for Cardiovascular Angiography and Interventions’ 35th Annual Scientific Sessions, 2012

A cardiac cath registry started since 2007 in the two largest cardiac centers in Egypt till Janua... more A cardiac cath registry started since 2007 in the two
largest cardiac centers in Egypt till January 2011, one in the National
Heart Institute(the largest cardiac center in Egypt) and the other in Ain
Shams university hospital ,the data collected in both centers utilize the
same data base system.