Layth Mimish - Academia.edu (original) (raw)

Papers by Layth Mimish

European Heart Journal, 2021

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...

The primary objective of this observational study is to compare clinical data and short-term outc... more The primary objective of this observational study is to compare clinical data and short-term outcome of patients admitted with acute coronary syndromes to coronary care unit in King Abdulaziz University Hospital over 1 year period, with patients enrolled in a multinational registry. The study cohort consisted of 399 patients hospitalized in King Abdulaziz University Hospital and 4,445 patients from the Global Registry of Acute Coronary Events. Average age of patients in King Abdulaziz University Hospital was nearly a decade younger (56 vs. 66 years), with male predominance (75% vs. 69%). Clinical presentation and management strategies were nearly the same, but in patients with ST elevation myocardial infarction, thrombolysis rather than primary percutaneous intervention was the main strategy in our group. In-hospital mortality rates were less in King Abdulaziz University Hospital patients (3% vs. 3.8%). This difference is probably related to smaller sample size, and late presentation. Future studies with larger sample size should explore the effects of differences in patient characteristics and treatment practices with long-term prognosis.

Journal of The Saudi Heart Association, 2012

European Journal of Heart Failure, Apr 12, 2016

We used data from a multicentre prospective registry of AHF patients created in Saudi Arabia. WHF... more We used data from a multicentre prospective registry of AHF patients created in Saudi Arabia. WHF was defined as recurrence of heart failure symptoms or signs-with or without cardiogenic shock. In-hospital short-and long-term outcomes, as well as predictors of WHF are described. Of the 2609 AHF patients enrolled, 33.8% developed WHF. WHF patients were more likely to have a history of heart failure and ischaemic heart disease. Use of intravenous vasodilators, inotropic agents, furosemide infusions, and discharge beta-blockers was significantly higher in WHF patients, while use of discharge ACE inhibitors was higher in patients without WHF. Length of hospital stay was significantly longer for WHF patients than for those without WHF [median (interquartile range) 13 (14) vs. 7 (7) days, P < 0.001]. In-hospital, 30-day, 1-year, and 2-year mortality rates were higher in WHF patients than in non-WHF patients. The adjusted odds ratios for in-hospital, 30-day, and 1-year mortality were 4.13 [95% confidence interval (CI) 2.74-6.20, P < 0.001], 3.17 (95% CI 2.21-4.56, P < 0.001), and 1.34 (95% CI 1.04-1.71, P = 0.021), respectively. The strongest predictors for WHF were having ischaemic cardiomyopathy, AHF with concomitant acute coronary syndrome, and low haemoglobin.

Journal of the Saudi Heart Association, 2020

Background: Low pulse pressure predicts long-term mortality in chronic heart failure, but its pro... more Background: Low pulse pressure predicts long-term mortality in chronic heart failure, but its prognostic value in acute heart failure is less understood. The present study was designed to examine the prognostic value of pulse pressure in acute heart failure. Methods: Pulse pressure was tested for its impact on short-and long-term mortality in all patients admitted with acute heart failure from October 2009 to December 2010 in eighteen tertiary centers in Saudi Arabia (n ¼ 2609). All comparisons were based on the median value (50 mmHg). Heart failure with reduced ejection fraction was defined as less than 40%. Results: Low pulse pressure was associated with increased short-term mortality in the overall population (

Journal of the Saudi Heart Association, 2018

Background: The prognostic impact of hyperglycemia (HG) in acute heart failure (AHF) is controver... more Background: The prognostic impact of hyperglycemia (HG) in acute heart failure (AHF) is controversial. Our aim is to examine the impact of HG on short-and long-term survival in AHF patients. Methods: Data from the Heart Function Assessment Registry Trial in Saudi Arabia (HEARTS) for patients who had available random blood sugar (RBS) were analyzed. The enrollment period was from October 2009 to December 2010. Comparisons were performed according to the RBS levels on admission as either <11.1 mmol/L or 11.1 mmol/ L. Primary outcomes were hospital adverse events and short-and long-term mortality rates. Results: A total of 2511 patients were analyzed. Of those, 728 (29%) had HG. Compared to non-HG patients, hyperglycemics had higher rates of hospital, 30-day, and 1-year mortality rates (8.8% vs. 5.6%; p = 0.003, 10.4% vs. 7.2%; p = 0.007, and 21.8% vs. 18.4%; p = 0.04, respectively). There were no differences between the two groups in 2-or 3-year mortality rates. After adjustment for relevant confounders, HG remained an independent predictor for hospital and 30-day mortality [odds ratio (OR) = 1.6; 95% confidence interval (CI) 1.07-2.42; p = 0.021, and OR = 1.55; 95% CI 1.07-2.25; p = 0.02, respectively]. Conclusion: HG on admission is independently associated with hospital and short-term mortality in AHF patients. Future research should focus on examining the impact of tight glycemic control on outcomes of AHF patients.

Angiology, 2017

Mineralocorticoid receptor antagonist (MRA) therapy is indicated after myocardial infarction in p... more Mineralocorticoid receptor antagonist (MRA) therapy is indicated after myocardial infarction in patients with acute heart failure (AHF) with an ejection fraction ≤40% and lacking contraindications. We analyzed clinical presentations, predictors, and outcomes of MRA-eligible patients within a prospective registry of patients with AHF from 18 hospitals in Saudi Arabia, from 2009 to 2010. For this subgroup, mortality rates were followed until 2013, and the clinical characteristics, management, predictors, and outcomes were compared between MRA-treated and non-MRA-treated patients. Of 2609 patients with AHF, 387 (14.8%) were MRA eligible, of which 146 (37.7%) were prescribed MRAs. Compared with non-MRA-treated patients, those prescribed MRAs more commonly exhibited non-ST-segment elevation myocardial infarction, acute on chronic heart failure, past history of ischemic heart disease, and severe left ventricular systolic dysfunction; were more commonly administered oral furosemide and dig...

The Lancet. Global health, Jul 2, 2017

Most data on mortality and prognostic factors in patients with heart failure come from North Amer... more Most data on mortality and prognostic factors in patients with heart failure come from North America and Europe, with little information from other regions. Here, in the International Congestive Heart Failure (INTER-CHF) study, we aimed to measure mortality at 1 year in patients with heart failure in Africa, China, India, the Middle East, southeast Asia and South America; we also explored demographic, clinical, and socioeconomic variables associated with mortality. We enrolled consecutive patients with heart failure (3695 [66%] clinic outpatients, 2105 [34%] hospital in patients) from 108 centres in six geographical regions. We recorded baseline demographic and clinical characteristics and followed up patients at 6 months and 1 year from enrolment to record symptoms, medications, and outcomes. Time to death was studied with Cox proportional hazards models adjusted for demographic and clinical variables, medications, socioeconomic variables, and region. We used the explained risk sta...

BMC Cardiovascular Disorders, 2016

Background: Little is know about the outcomes of acute heart failure (AHF) with acute coronary sy... more Background: Little is know about the outcomes of acute heart failure (AHF) with acute coronary syndrome (ACS-AHF), compared to those without ACS (NACS-AHF). Methods: We conducted a prospective registry of AHF patients involving 18 hospitals in Saudi Arabia between October 2009 and December 2010. In this sub-study, we compared the clinical correlates, management and hospital course, as well as short, and long-term outcomes between AHF patients with and without ACS. Results: Of the 2609 AHF patients enrolled, 27.8 % presented with ACS. Compared to NACS-AHF patients, ACS-AHF patients were more likely to be old males (Mean age = 62.7 vs. 60.8 years, p = 0.003, and 73.8 % vs. 62.7 %, p < 0.001, respectively), and to present with De-novo heart failure (56.6 % vs. 28.1 %, p < 0.001). Additionally they were more likely to have history of ischemic heart disease, diabetes, dyslipidemia, and less likely to have chronic kidney disease (p < 0.001 for all comparisons). The prevalence of severe LV systolic dysfunction (EF < 30 %) was higher in ACS-AHF patients. During hospital stay, ACS-AHF patients were more likely to develop shock (p < 0.001), recurrent heart failure (p = 0.02) and needed more mechanical ventilation (p < 0.001). β blockers and Angiotensin Converting Enzyme inhibitors were used more often in ACS-AHF patients (p = 0.001 and, p = 0.004 respectively). ACS-AHF patients underwent more coronary angiography and had higher prevalence of multi-vessel coronary artery disease (p < 0.001 for all comparisons). The unadjusted hospital and one-month mortality were higher in ACS-AHF patients (OR = 1.6 (1.2-2.2), p = 0.003 and 1.4 (1.0-1.9), p = 0.026 respectively). A significant interaction existed between the level of left ventricular ejection fraction and ACS-AHF status. After adjustment, ACS-AHF status was only significantly associated with hospital mortality (OR = 1.6 (1.1-2.4), p = 0.019). The three-years survival following hospital discharge was not different between the two groups.

European Journal of Heart Failure, 2016

Angiology, 2015

We assessed sex-specific differences in clinical features and outcomes of patients with acute hea... more We assessed sex-specific differences in clinical features and outcomes of patients with acute heart failure (AHF). The Heart function Assessment Registry Trial in Saudi Arabia (HEARTS), a prospective registry, enrolled 2609 patients with AHF (34.2% women) between 2009 and 2010. Women were older and more likely to have risk factors for atherosclerosis, history of heart failure (HF), and rheumatic heart and valve disease. Ischemic heart disease was the prime cause for HF in men and women but more so in men ( P < .001). Women had higher rates of hypertensive heart disease and primary valve disease ( P < .001, for both comparisons). Men were more likely to have severe left ventricular systolic dysfunction. On discharge, a higher use of angiotensin-converting enzyme inhibitors, β-blockers, and aldosterone inhibitors was observed in men ( P < .001 for all comparisons). Apart from higher atrial fibrillation in women and higher ventricular arrhythmias in men, no differences were ob...

Vascular and Endovascular Surgery, 1992

Surgical angioplasty of the left main coronary artery for severe ostial stenosis in a thirty-five... more Surgical angioplasty of the left main coronary artery for severe ostial stenosis in a thirty-five-year-old oriental woman suffering from Takayasu's disease was performed by use of an onlay autologous pericardial patch through an anterior aortotomy approach. This procedure was performed to reestablish a physiologic antegrade coronary arterial flow and to avoid use of internal mammary arteries, which have little flow in Takayasu's disease, or the saphenous veins, which can also be involved in the inflammatory process. The procedure also avoids a lengthy, time-consuming triple coronary artery bypass procedure and the use of saphenous veins, which are prone to certain slow or rapid attrition. Total clinical improvement with disappearance of angina and return of the patient to NYHA functional class I with normal treadmill exercise response was immediately obtained. Angiographic restudy six months after the surgical angioplasty revealed excellent results with complete wide patency of the ostium. This represents the first report in the world literature of surgical angioplasty of a left main coronary arterial ostial stenosis in Takayasu's disease.

Annals of Saudi medicine

To describe the distribution of body mass index (BMI) and its relationship with clinical features... more To describe the distribution of body mass index (BMI) and its relationship with clinical features, management, and in-hospital outcomes of patients admitted with acute coronary syndromes (ACS). The Saudi Project for Assessment of Coronary Events is a prospective registry. ACS patients admitted to 17 hospitals from December 2005-2007 were included in this study. BMI was available for 3469 patients (68.6%) admitted with ACS and categorized into 4 groups: normal weight, overweight, obese, and morbidly obese. Of patients admitted with ACS, 72% were either overweight or obese. A high prevalence of diabetes (57%), hypertension (56.6%), dyslipidemia (42%), and smoking (32.4%) was reported. Increasing BMI was significantly associated with diabetes, hypertension, and hyperlipidemia. Overweight and obese patients were significantly younger than the normal-weight group (P=.006). However, normal-weight patients were more likely to be smokers and had 3-vessel coronary artery disease, worse left ...

The Journal of heart valve disease, 1999

A 15-year-old boy with severe pulmonary stenosis associated with severe right and left ventricula... more A 15-year-old boy with severe pulmonary stenosis associated with severe right and left ventricular systolic dysfunction is reported. After successful percutaneous pulmonary valvuloplasty, there was an initial and early improvement in right ventricular (RV) function, followed by a delayed and more gradual improvement in left ventricular (LV) function. At long-term follow up, both RV and LV systolic functions were nearly normalized. Several mechanisms may be implicated, including ventricular interdependence, geometric factors, altered compliance and intrinsic alteration in the LV muscle. A delayed, but sustained, improvement in LV systolic function following relief of RV pressure overload suggests that the latter mechanism must have played an important role in the genesis of the LV dysfunction. Pulmonary stenosis associated with severe biventricular dysfunction may be treated primarily by percutaneous pulmonary balloon valvuloplasty with near-total recovery of the ventricular function.

Canadian Journal of Cardiology, 2014

with more feminine gender scores (tertile 3) were more likely to be women, be unmarried, report h... more with more feminine gender scores (tertile 3) were more likely to be women, be unmarried, report high anxiety and depression, low stress management abilities, as well as more diabetes, hypertension, family history of CAD and prior CVD events before the index ACS than patients with more androgynous (tertile 2) and masculine (tertile 1) gender scores. Of the 35 (3%) patients with recurrent ACS at one year, the proportion was higher in tertile 3 (5%) than in the less feminine tertiles of the gender score: tertiles 2 (2%) and 1 (2%). This difference persisted after multivariable adjustment; patients in tertile 3 remained at greater risk of recurrent ACS than patients in tertiles 2 and 1 (HR1⁄44.50, 95% CI: 1.05-19.27, p1⁄40.04). Factors that moderated the association between feminine gender and recurrent ACS included anxiety,marital status and access to ACS care at baseline.Of note, recurrent ACS did not vary by sex: 3% in bothmales and females. CONCLUSION: In younger patients with ACS, feminine gender, but not female sex, is associated with recurrent ACS. Increased anxiety and poorer access to care in men and women with strong feminine gender characteristics may help explain this association. Studies of sex differences in cardiovascular disease should consider gender-based conceptual frameworks.

Global Heart, 2014

O ST E R A B ST R A C T S Conclusion: This is the first study about time of day impact on AHFS tr... more O ST E R A B ST R A C T S Conclusion: This is the first study about time of day impact on AHFS treatment. Vital signs are significant different between daytime and nighttime, which made us think about the treatment options. Therefore, it is clinically important to know about the nighttime is high prevalence of AHFS patients in whom we should consider vasodilator therapy. Disclosure of Interest: None Declared

Journal of the Saudi Heart Association, 2011