Compliance with Guideline-Recommended Management in Patients with Non-ST-Elevation Acute Coronary Syndromes: Findings from the Gulf COAST Registry

Background: Evaluation of management practices and adherence to treatment guidelines are essential components of improved health-care delivery. Despite the improvement in the implementation of guidelines, the medical management of acute coronary syndrome (ACS) remains suboptimal worldwide. The aim of the present study was to determine medication use patterns, recent trends, and prescription predictors of adherence to guideline-based therapies for non-ST-elevation ACS (NSTE-ACS) in the Middle East. Methods: We evaluated the use of a quadruple evidence-based medication (EBM) combination consisting of the concurrent use of dual antiplatelet therapy, β-blockers, and lipid-lowering agents at discharge among patients ( n = 2782) with NSTE-ACS in four Middle Eastern countries. Results: A total of 56% ( n = 1626) of the patients received all four guideline-recommended medications at hospital discharge. An adjusted model demonstrated that male sex, diabetes, dyslipidemia, prior percutaneous coronary intervention, prior myocardial infarction, prior coronary artery bypass graft, admission to a catheterization-equipped hospital, and smoking were positively correlated with EBM prescription on discharge. Conversely, cardiogenic shock, heart failure, renal impairment, higher GRACE risk score, and bleeding negatively correlated with concurrent use of the quadruple EBM combination. Conclusion: Nearly half of NSTE-ACS patients in the Middle East do not receive the quadruple EBM combination. Efforts are needed to bridge this gap between practice and guidelines.