Adherence to ACC/AHA Performance Measures for Myocardial Infarction in Six Middle-Eastern Countries: Association with In-Hospital Mortality and Clinical Characteristics

Joseph C. Longenecker, Abdulhamied Alfaddagh, Mohammad Zubaid, Wafa Rashed, Mustafa Ridha, Fahad Alenezi, Rashed Alhamdan, Mousa Akbar, Bassam Y. Bulbanat, Jassim Al-Suwaidi

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Background/Objectives: This study assesses adherence to performance measures for acute myocardial infarction (AMI) in six Middle-Eastern countries, and its association with in-hospital mortality. Few studies have previously assessed these performance measures in the Middle East. Methods: This cohort study followed 5813 patients with suspected AMI upon admission to discharge. Proportions of eligible participants receiving the following performance measures were calculated: medications within 24 hours of admission (aspirin and beta-blocker) and on discharge (aspirin, beta-blockers, angiotensin converting enzyme inhibitors [ACEI], and lipid-lowering therapy), reperfusion therapy, and low-density lipoprotein (LDL) cholesterol measurement. A composite adherence score was calculated. Associations between performance measures and clinical characteristics were assessed using multivariate logistic regression. Results: Adherence was above 90% for aspirin, reperfusion, and lipid-lowering therapies; between 60% and 82% for beta-blockers, ACEI, statin therapy, time-to-balloon within 90 minutes, and LDL-cholesterol measurement; and 33% for time-to-needle within 30 minutes. After adjustment, factors associated with high composite performance score (> 85%) included Asian ethnicity (Odds Ratio, OR = 1.3; p = 0.01) and history of hyperlipidemia (OR = 1.4; p = 0.001). Factors associated with a lower score included atypical symptoms (OR = 0.6; p = 0.003) and high GRACE score (OR = 0.6; p < 0.001). Lower in-hospital mortality was associated with provision of reperfusion therapy (OR = 0.54, p = 0.047) and beta-blockers within 24 hours (OR = 0.33, p = 0.005). Conclusions: Overall adherence was lowest among the highest-risk patients. Lower in-hospital mortality was independently associated with adherence to early performance measures, comprising observational evidence for their effectiveness in a Middle East cohort. These data provide a focus for regional quality improvement initiatives and research.

Original languageEnglish (US)
Pages (from-to)1406-1411
Number of pages6
JournalInternational Journal of Cardiology
Issue number4
StatePublished - Aug 20 2013
Externally publishedYes


  • Adherence
  • Guidelines
  • Middle East
  • Mortality
  • Myocardial Infarction
  • Performance Measures

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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