Shoby, Mohamed, Arafah, Mohammed, Alsayed, Mohamed, Al suwaidi, Jassim M, Baslaib, Fahad, Rajadhyaksha, Viraj, Nibouche, Djamaleddine, Hany, Ragy, Rhouati, Adel, Bazargani, Nooshin, and Guindy, Ramez
Introduction:The TOURACO study aimed to describe the short- and long-term (i.e., up to 3 years following the index event) management in patients hospitalized for an ACS, and the compliance with ESC and AHA/ACC guidelines in a ‘real-life’ setting in the Middle East and North Africa (MENA) area.Methods:TOURACO is an observational prospective study on adults hospitalized within 24 hours of ACS onset between December 2015 and February 2017 and having given written informed consent, in Algeria, Bahrain, Egypt, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. Initial care, hospitalization and follow-up (1, 6, 12, 24 and 36 months after hospital discharge) data were recorded. Patients were followed-up until April 2020.Results:1,131 eligible patients (mean age: 56 [49; 64] years; 927 (82.0%) males; median BMI: 28.1 [25.1; 31.6] kg/m2) were included; 602 (53.2%) patients had a STEMI, 306 (27.1%) patients a NSTEMI and 223 (19.7%) patients an UA. The most common risk factor was hypercholesterolemia, affecting more than half of the patients, and 43% of the patients were current smokers. However, during the 3 months preceding ACS, only 191 (17.1%) patients received an anti-thrombotic agent, 14 (1.3%) at least 2 anti-platelet agents, 151 (13.5%) patients a cholesterol lowering agent, 135 (12.1%) patients an anti-diabetic agent and 233 (20.9%) an anti-hypertensive agent. Compliance with guidelines 1 month after discharge was high (79.2%). At 1 year, compliance was available for 614 (55%) and remained high (77%). Compliance decreased overtime and reached 65% at 3 years. Cumulative mortality rate was relatively low with a rate of 1.7 ±0.4% at 1 month, 3.8±0.6% at 1 year, 5.1±0.7% at 2-year and 6.2±0.7% at 3-years.Conclusions:TOURACO is the first study assessing compliance of treatments with international guidelines in the MENA region. Compliance was good 1 month after the ACS episode and remained high for the next 3 years likely responsible for the low mortality. However, patient’s baseline characteristics at arrival were not optimum: a high proportion of patients were not treated for their diabetes and their hypertension , and smoking cessation. This study highlights the importance of preventive therapies.