Purpose: Young women are at risk of acute coronary syndrome (ACS). They represent a unique population exposed to traditional cardiovascular risk factors and female sex-specific, non-traditional risk factors. The current study aimed to describe traditional and non-traditional risk factors of ACS in young women from the Middle East. Patients and Methods: The present study used data from the Jordanian, nationwide, multicenter, case-control study, ANCORS-YW. Bivariate analyses and logistic regression models were used to predict independent risk factors of ACS using adjusted odds ratios (AOR) and 95% confidence intervals (CI). Results: The study included 572 young women (<= 50-years) with a median age of 45-years, divided into an ACS group (n=154, 26.9%) and a control group with no atherosclerotic cardiovascular disease (n=418, 73.1%). The most common presentation of ACS was non-ST-elevation ACS (n=98, 64%). The ACS group, compared to control group, had higher proportions of type-2 diabetes (41.6%vs.11.7%, p<0.001), hypertension (53.9%vs.23.4%, p<0.001), tobacco use (37.7%vs.24.2%, p=0.001), family history of cardiovascular disease (53.2%vs.23.4%, p<0.001), metabolic syndrome (14.3%vs.2.4%, p<0.001), and preterm delivery (24.7% vs.16.7%, p=0.032). ACS group had nonsignificantly greater proportions of hypertensive disorders of pregnancy (29.2%vs.22.7%, p=0.109) and gestational diabetes (15.6%vs.10.3%, p=0.081). Multivariable logistic regression analyses identified five independent predictors of ACS: type-2 diabetes (AOR, 95% CI: 3.45, 1.98-5.99), family history of cardiovascular disease (3.33, 2.15-5.17), tobacco use (2.01, 1.26-3.21), hypertension (1.72, 1.07-2.78), and metabolic syndrome (4.35, 1.72-11.03). Conclusion: Modifiable risk factors play an important role in ACS risk among young women. Efforts should be made to improve primordial and primary prevention in this population.

Background and Objectives: Hypertension (HTN) constitutes a significant global health burden, yet the specific genetic variant responsible for blood pressure regulation remains elusive. This study investigates the genetic basis of hypertension in the Jordanian population, focusing on gene variants related to ion channels and transporters, including KCNJ1, WNK1, NPPA, STK39, LUC7L2, NEDD4L, NPHS1, BDKRB2, and CACNA1C. Materials and Methods: This research involved 200 hypertensive patients and 224 healthy controls. Whole blood samples were collected from each participant, and genomic DNA was extracted. The genetic distribution of the polymorphisms was analyzed. The haplotype frequencies were investigated using the SNPStats web tool, and the genotype and allele frequencies of the studied variants were assessed using the χ2 test. Results: Sixteen single nucleotide polymorphisms (SNPs) from nine genes were evaluated. A significant association was observed between the rs880054 variant of the WNK1 gene and hypertension susceptibility, with the T allele elevating the risk of hypertension. This association remained important in the codominant model (p = 0.049) and the dominant model (p = 0.029). In addition, rs880054 was associated with clinical characteristics such as triglyceride levels and cerebrovascular accidents (p-value > 0.05). Conclusions: Our findings reveal a significant link between the rs880054 SNP and an increased hypertension risk, suggesting that variations in WNK1 may be crucial in regulating blood pressure. This study provides new insights into the genetic factors contributing to hypertension and highlights the potential of WNK1 as a target for future therapeutic interventions.

Abstract Introduction Urbanization is an important contributor to atherosclerotic cardiovascular disease (ASCVD) in the Middle East, especially in the younger age groups. There is a scarcity of data on clinical profiles and cardiovascular risk factors (RFs) in urban young women compared with those who reside in rural areas in this region. Purpose To study the demographic and clinical profiles and prevalence of traditional and novel CV RFs in a cohort study of young urban Middle Eastern women compared with those in rural areas. Methods The prevalence of 19 traditional and novel cardiovascular RFs were compared in urban vs. rural young women residents (18-50 years of age), who were enrolled in 12 centers (August 2020 to October 2023). Results Of 627 young women enrolled (mean age 44.2 ± 5.1 years old), 463 (74%) were urban residents and 164 (26%) were rural residents. ASCVD was diagnosed in 32% of urban and 37.3% of rural young women. Table shows the prevalence of traditional and novel, sex-specific RFs with significant differences in the 2 groups. Other RFs with no significant differences included hypertension, diabetes and gestational diabetes, preterm delivery, persistent weight gain after delivery, radiation for breast cancer, and polycystic ovary syndrome. Conclusion In this cohort of Middle Eastern young women, despite heterogeneity, those who were urban residents had worse clinical profiles with higher prevalence of certain classical and sex-specific risk factors.

Hypertension is one of the most common and complicated disorders associated with genetic and environmental risk factors. The angiotensin-converting enzyme (ACE) is important in the renin-angiotensin-system pathway. The gene expression of ACE has been investigated as a possible hypertension marker. This study investigates the association between polymorphisms within the ACE1 and ACE2 genes and hypertension susceptibility in a Jordanian population. The study comprised a total of 200 hypertensive patients and 180 healthy controls. A polymerase chain reaction (PCR) was performed to genotype the candidate polymorphism (rs4646994) of the ACE1gene. The Luminex DNA array technique was used for genotyping SNPs (rs4359, rs4344, rs4341, rs4343, and rs2106809) of the ACE1 and ACE2 genes. Our findings suggest no association between SNPs and hypertension regarding allelic and genotypic frequencies. However, rs4359 was significantly associated with diet (pP = 0.049), know HTN (P = 0.042), and number of years DM (P = 0.003). rs4341 was associated with diet (P = 0.032), peripheral vascular disease (P = 0.005), and chronic kidney disease (p = 0.049). While rs4343 was associated with diet (P = 0.031), diabetes mellitus (P = 0.032), and other medication (P = 0.025). Furthermore, the haplotypes of four SNPs of the ACE1 gene showed no significant association with HTN patients and healthy controls. Our findings indicate no association between the polymorphisms in the ACE gene and the risk of hypertension development in the Jordanian adult population.

Mortality rate due to coronary artery disease (CAD) is elevated among diabetes mellitus (DM) compared to non-DM patients. Endothelin 1 (ET-1), a potent vasoconstrictor, is implicated in the pathophysiology of both CAD and DM. The impact of ET-1 on the short-term clinical outcomes following revascularization by percutaneous coronary intervention (PCI) and coronary artery bypass surgery (CABG) remains unclear. We investigated the impact of ET-1 on clinical outcomes and revascularization strategies in CAD patients, exploring the role of DM on modifying these relationships. In a prospective observational study, patients presenting to cardiac catheterization lab for CAD evaluation at a Jordanian hospital were enrolled and stratified by status of CAD and DM. Plasma levels of ET-1 were measured before catheterization. Short-term clinical outcomes and prognosis were compared.Among 815 enrolled patients (603 CAD and 212 controls), DM prevalence was higher among CAD patients than non-CAD. Plasma ET-1 levels were measured in 490 random patients and were associated with CAD and the need for revascularization. Multivariate analysis independently revealed higher plasma ET-1 levels in DM patients requiring revascularization. Short-term follow-up for 366 patients (median of 4 months) showed that 132 developed one cerebro/cardiovascular event, predominantly among DM patients. Baseline ET-1 was not associated with higher risk of the first event. Notably, revascularization by PCI was associated with lower event risk in DM patients.Our study indicates that plasma ET-1 levels are associated with the need for revascularization in DM patients, with those undergoing PCI having a lower risk of initial cerebro/cardiovascular events.

Background and Objectives: Heart failure (HF) is a prevalent and debilitating condition that imposes a significant burden on healthcare systems and adversely affects the quality of life of patients worldwide. Comorbidities such as chronic kidney disease (CKD), arterial hypertension, and diabetes mellitus (DM) are common among HF patients, as they share similar risk factors. This study aimed to identify the prognostic significance of multiple factors and their correlation with disease prognosis and outcomes in a Jordanian cohort. Materials and Methods: Data from the Jordanian Heart Failure Registry (JoHFR) were analyzed, encompassing medical records from acute and chronic HF patients attending public and private cardiology clinics and hospitals across Jordan. An online form was utilized for data collection, focusing on three kidney function tests, estimated glomerular filtration rate (eGFR), blood urea nitrogen (BUN), and creatinine levels, with the eGFR calculated using the Cockcroft–Gault formula. We also built six machine learning models to predict mortality in our cohort. Results: From the JoHFR, 2151 HF patients were included, with 644, 1799, and 1927 records analyzed for eGFR, BUN, and creatinine levels, respectively. Age negatively impacted all measures (p ≤ 0.001), while smokers surprisingly showed better results than non-smokers (p ≤ 0.001). Males had more normal eGFR levels compared to females (p = 0.002). Comorbidities such as hypertension, diabetes, arrhythmias, and implanted devices were inversely related to eGFR (all with p-values <0.05). Higher BUN levels were associated with chronic HF, dyslipidemia, and ASCVD (p ≤ 0.001). Higher creatinine levels were linked to hypertension, diabetes, dyslipidemia, arrhythmias, and previous HF history (all with p-values <0.05). Low eGFR levels were associated with increased mechanical ventilation needs (p = 0.049) and mortality (p ≤ 0.001), while BUN levels did not significantly affect these outcomes. Machine learning analysis employing the Random Forest Classifier revealed that length of hospital stay and creatinine >115 were the most significant predictors of mortality. The classifier achieved an accuracy of 90.02% with an AUC of 80.51%, indicating its efficacy in predictive modeling. Conclusions: This study reveals the intricate relationship among kidney function tests, comorbidities, and clinical outcomes in HF patients in Jordan, highlighting the importance of kidney function as a predictive tool. Integrating machine learning models into clinical practice may enhance the predictive accuracy of patient outcomes, thereby supporting a more personalized approach to managing HF and related kidney dysfunction. Further research is necessary to validate these findings and to develop innovative treatment strategies for the CKD population within the HF cohort.

Background:Obstructive Sleep Apnea (OSA) is a common respiratory disorder that causes intermittent upper airway collapse during sleep and can lead to various acute cardiovascular complications. Atrial Fibrillation (AF) is the most common sustained cardiac arrhythmia and is associated with an increased risk of cardiovascular hospitalization and all-cause mortality. Our study aimed to investigate the prevalence of individuals with AF and those considered at high risk for OSA.Methods:A cross-sectional study was conducted with a population comprising patients who had visited KAUH cardiology clinics between 2017-2019; subjects were categorized into AF patients and general cardiology patients. Patients were surveyed for OSA using the Berlin Questionnaire to assess the degree of OSA symptoms and to classify patients into high- or low-risk groups based on their responses.Results:Of the 656 patients, 545 met our inclusion criteria, of whom 192 were diagnosed with AF. Comparable demographic characteristics were observed between the AF and non-AF groups, barring higher rates of obesity (p=0.001) and smoking (p=0.042) in the AF group. The prevalence of high-risk OSA was significantly higher in AF patients (68.2%) compared to non-AF patients (29.4%), with an adjusted odds ratio of 2.473 times (95% CI: 1.434 -4.266, p=0.001) greater for AF. The age, gender, and BMI categories did not differ significantly between the two groups. Binary logistic regression revealed significant associations between OSA and risk factors such as asthma (OR=4.408, 95% CI: 2.634-7.376, p=0.001).Conclusion:These results serve to display a statistically significant increase in high-risk OSA in existing AF patients, irrespective of the presence of conventional OSA risk factors; this could imply a more immediate and direct relationship between both diseases and calls to include routine screening for OSA in patients diagnosed, newly or otherwise, with AF.

Background:During COVID-19 lockdown periods, several studies reported decreased numbers of myocardial infarction (MI) admissions. The lockdown impact has not yet been determined in developing countries. The aim of this study was to investigate the impact that of the lockdown measures might have had on the mean number of MI hospital admissions in Northern Jordan.Methodology:A single-center study examined consecutive admissions of MI patients during COVID-19 outbreak. Participants' data was abstracted from the medical records of King Abdullah University Hospital between 2018 and 2020. Mean and percentages of monthly admissions were compared by year and by lockdown status (pre-lockdown, lockdown, and post-lockdown time intervals).Results:A total of 1380 participants were admitted with acute MI symptoms: 59.2% of which were STEMI. A decrease in number of MI admissions was observed in 2020, from 43.1 (SD: 8.017) cases per month in 2019 to 40.59 (SD: 10.763) in 2020 (P < 0.0001) while an increase in the numbers during the lockdown was observed. The mean number during the pre-lockdown period was 40.51 (SD: 8.883), the lockdown period was 44.74 (SD: 5.689) and the post-lockdown was 34.66 (SD: 6.026) (P < 0.0001 for all comparisons). Similar patterns were observed when percentages of admissions were used.Conclusion:Upon comparing the lockdown period both to the pre- and post-lockdown periods separately, we found a significant increase in MI admissions during the lockdown period. This suggests that lockdown-related stress may have increased the risk of myocardial infarction.

Background and Purpose:CHA2DS2-VASc score is one of the most widely used scoring systems to assess the risk of systemic embolization and stroke in patients suffering from atrial fibrillation (Afib); furthermore, it is important in guiding their treatment. This study aimed to evaluate the predictivity of this score in the Jordanian population, build a deeper understanding of patients' demographic and risk factors, and assess the usefulness of anticoagulation as a preventive measure.Methods:A total of 2020 patients with Afib registered in the Jordanian Atrial Fibrillation (JoFib) registry were enrolled in this study. All patients were followed up for 1 year to assess their susceptibility to develop cerebrovascular accident (CVA) and systemic embolism (SE). The association between CHA2DS2-VASc score and risk of development of stroke or systemic embolization was analyzed based on bivariate and adjusted multivariate analyses. The ROC curve was used to assess the predictivity of the CHA2DS2-VASc score.Results:The mean age of the study population was 67.8 years; 45.8% were males, and 81.8% were on anticoagulants. And, 71.8% had a CHA2DS2-VASc score of ≥3. During the follow-up period of 1 year; 69 developed new CVA (mean age, 72.8 years), and 9 developed SE. A total of 276 patients died; 18 patients died (6.5% out of all deceased)% from CVA. A moderate predictive power of the CHA2DS2-VASc score was demonstrated through ROC curve analysis with C statistics of 0.689 CI (0.634 to 0.744) for predicting the development of SE or CVA at 1 year.Conclusion:CHA2DS2-VASc showed a moderate predictivity of stroke, SE, and all-cause mortality at 1 year. The study suggested disregarding gender differences in deciding to initiate anticoagulant therapy.

Background Prevention of stroke and systemic embolism (SE) prevention in patients with atrial fibrillation (AF) has radically changed in recent years. Data on contemporary utilization of oral anticoagulants (OACs) and cardiovascular outcome in Middle Eastern patients with AF are needed. Methods The Jordan atrial fibrillation (JoFib) study enrolled consecutive patients with AF in Jordan from May 2019 through October 2020 and were followed up for one year after enrollment. Results Overall, 2020 patients were enrolled. The mean age was 67.9 + 13.0 years. Nonvalvular (NVAF) was diagnosed in 1849 (91.5%) patients. OACs were used in 85.7% of high-risk patients with NVAF (CHA2DS2-VASc score>3 in women, and>2 in men), including direct OACs (DOACs) in 64.1% and vitamin K antagonists (VKA) in 35.9%. Adherence rate to the use of the same OAC agent was 90.6% of patients. One-year cardiovascular (CV) mortality was 7.8%, stroke/SE was 4.5%, and major bleeding events were 2.6%. Independent predictors for all-cause mortality in patients with NVAF were age>75 years, heart failure, major bleeding event, type 2 diabetes mellitus, study enrollment as an in-patient, and coronary heart disease. The use of OACs was associated with lower all-cause mortality. The strongest independent predictors for stroke/SE were high-risk CHA2DS2-VASc score and prior history of stroke. Conclusions This study of Middle Eastern AF patients has reported high adherence to OACs. The use of OACs was associated with a lower risk for all-cause mortality. One-year rates of stroke and major bleeding events were comparable to those reported from other regions in the world.

Background and Aims: The Covid-19 pandemic-related stressors are associated with behavioral and psychological problems, but no reports describe the pandemic stress triggering acute coronary events including acute myocardial infarction (AMI) and out-of-hospital cardiac arrest (OHCA) among individuals not infected with the covid-19 virus. Methods: We enrolled Covid-19 negative patients with AMI or OHCA admitted to 8 centers in Jordan during the covid-19 pandemic (March 15 through December 31, 2020). All of the patients were exposed to pandemic-related psychosocial and financial stressors. Results: We enrolled 177 patients (mean age 59.6+9.9 years, 84% men). Hypertension was present in 50%, diabetes in 45%, cigarette smoking in 71%, and 36% had history of cardiovascular disease (CVD). Of the whole group, 166 (94%) had AMI and 11 (6%) had OHCA. Patients with OHCA were younger (55.0+7.1 vs. 59.9+10.7 years, p<0.05) and had lower rate of past CVD (9% vs. 37%, p<0.001) compared with AMI patients. Of the AMI patients, 147 (83%) had coronary angiography, 119 (67%) had percutaneous angioplasty and 14 (8%) had bypass surgery. Survival rate was 0 for the OHCA patients and 98.2% for AMI patients (p<0.0001). The most common reported pandemic-related triggers the patients were exposed to included financial hardships in 82 (46%), loneliness in 77 (44%), fear to contract the virus or of lack of medical care in 55 (31%), anger in 29 (16%), and heavy physical exertion in 8 patients (5%). Conclusions: The Covid-19 pandemic-related stressors can potentially trigger life threatening acute coronary events. The minority of patients who had OHCA had a grim prognosis.

Background: COVID-19 may have a role in myocardial injury in some patients, which can lead to multiple cardiovascular consequences. Electrocardiography (ECG) is useful to detect cardiac involvement of COVID-19. Objective: In this study, we aimed to identify the pattern of ECG findings in COVID-19 patients. Methods: We retrospectively evaluated the clinical data of 176 patients diagnosed with COVID-19 along with their ECG findings on admission and during hospitalization. Results: Out of 176 patients, 56.8% were males. The mean age of the patients was 64.4 (SD: 15.4) years. Twenty-five patients were obese (Body mass index “BMI” > 30). Comorbidities including hypertension, diabetes mellitus, and coronary artery disease were found in 70.5%, 52.3%, and 24.4% of patients, respectively. Only 17% of patients had normal ECG readings, and the rest had abnormalities of various types. Heart rate was normal in 67.6% of patients, the rest were tachycardiac (29.0%) or bradycardiac (3.4%). Findings included a widened QRS complex in 6.2% of patients, 79.0% of patients had a prolonged PR interval, and 9.1% had a prolonged QT interval. The most common ECG abnormalities were sinus tachycardia (20.5%) and atrial fibrillation (18.2%). We found a correlation between mortality and atrial fibrillation (p=0.021) and ventricular premature contraction (p=0.007). As for complications, atrial fibrillation and sinus tachycardia were significantly correlated with major complications including death, need for positive pressure ventilation (PPV), intensive care unit (ICU) admission, myocardial infarction, and acute respiratory distress syndrome (ARDS). Conclusion: ECG is a robust indicator of myocardial involvement of the COVID-19 patients. This study highlighted the diagnostic and prognostic importance of conducting ECG on admission and during hospitalization for COVID-19 patients. More investigation is required to determine the diagnostic accuracy and prognostic value of this modality.

Abstract Background Atrial fibrillation (AF) is the most common sustained arrhythmia in women and men worldwide and in the Middle East. Several studies have shown that women with AF are undertreated despite worse baseline clinical and risk profiles compared with men. It is largely unknown if this also applies to Middle Eastern AF patients. Purpose To evaluate baseline clinical features and utilization of guideline-recommended oral anticoagulant medications (OACs) in Middle Eastern women with AF. Methods The Jordan AF prospective multicenter study enrolled 2160 patients with AF, including 1164 (53.9%) women, in 20 hospital and outpatient clinics (May 2019 through January 2021). Results Nonvalvular AF was present in 1038 (91.0%) of women and 935 (94.6%) of men. Compared with men, women were older (mean age 69.2±11.5 years vs. 66.1±14.9 years, p<0.001), and had higher prevalence of hypertension (79.1% vs. 69.5%, p<0.001), diabetes (46.1% vs. 41.7%, p=0.04) and obesity (60.5% vs. 34.6%, p<0.001). Women, however, had lower prevalence of two comorbidities; heart failure (21.5% vs. 28.6, p=0.001) and coronary artery disease (7.7% vs. 15.4%, p<0.001) compared with men. Rate of utilization of oral anticoagulant agents (OACs) was higher in women than men with high and intermediate CHA2DS2 VASc scores (Table). Direct OACs were used in 64.0% of women and 63.3% of men with high risk score (p=NS). Multivariate analysis did not show sex to be an independent predictor of use of OACs. Conclusions Middle Eastern women with AF have worse baseline clinical and risk score profiles compared with men. In disagreement with other regional studies, the majority of these women received guideline-recommended OACs. Funding Acknowledgement Type of funding sources: None.

Background The main objective of this study is sought to determine the impacts of PCSK9, WDR12, CDKN2A, and CXCL12 polymorphisms on warfarin sensitivity and responsiveness in Jordanian cardiovascular patients during the initiation and stabilization phases of therapy. Methods This study took place at the anticoagulation clinic at Queen Alia Heart Institute (QAHI) in Jordan. DNA samples were collected from 212 cardiovascular patients and 213 healthy controls. Genomic SNPs genotyping was conducted using the MassARRAY System at the Australian Genome Research Facility. Results This study assessed 10 polymorphisms (rs11206510 within the PCSK9 gene, rs6725887 and rs7582720 within the WDR12 gene, rs4977574, rs10757278, and rs1333049 within the CDKN2A gene, rs2862116, rs7906426, rs1746048, and rs268322 within the CXCL12 gene) in 212 Jordanian cardiovascular patients. Carriers of CDKN2A rs1333049, rs10757278, and PCSK9 rs11206510 polymorphisms had an increased risk of resistance during the initiation phase of warfarin therapy compared to those who do not carry it, or those who are carrying one polymorphism only (P < 0.05), while carriers of CXCL12 rs7906426 polymorphism had similar increased risk but during the stabilization phase of warfarin therapy (P < 0.05). Conclusion Carriers of CXCL12 rs2862116 polymorphism had an increased risk to be warfarin extensive responders compared to those with no or only one polymorphism (P = 0.01). However, the presence of PCSK9 rs11206510 polymorphism affects the warfarin maintenance doses (P ˃ 0.0001).

Background: Depression and cardiovascular disorders are significant determinants of health that affect the quality of life and life expectations. Despite the high importance of depression screening among Coronary Artery Disease (CAD) patients, the time being to assess and treat it remains controversial. Objectives: This study aims to assess the prevalence estimates and severity of depressive symptoms and determine the risk factors associated with developing such symptoms among CAD patients after ten days of Percutaneous Coronary Intervention (PCI). Methods: All patients who underwent elective PCI between October 5, 2019, and Mid-March 2020 and diagnosed with CAD were included in this cross-sectional study. CAD was defined as intra-luminal stenosis of ≥ 50% in one or more of the coronary arteries. Depressive symptoms were screened after ten days of the PCI utilizing the patient health questionnaire-9 (PHQ-9) tool. A linear regression model was used to assess the adjusted effects of independent variables on PHQ-9 scores. Electronic medical records, clinical charts, and PCI and echocardiogram reports were reviewed. Results: Out of 385 CAD patients, a total of 335 were included in this study, with a response rate of 87%. The participants' mean (±SD) age was 57.5±10.7 years, 75.2% were males, 43% were current smokers, and 73.7% had below bachelor's education. The prevalence estimates of patients with moderate to severe depressive symptoms (PHQ-9 ≥10) was 34%, mild depression 45.1%, and normal 20.9%. Female gender, low educational level and diabetes mellitus were found to be the significant independent predictors of depression among our cohort with (t(333) = 3.68, p<0.001); (t(333) = 5.13, p<0.001); and (t(333) = 2.79, p=0.042), respectively. Conclusion: This study suggests a high prevalence of depressive symptoms among CAD patients after ten days of PCI. Approximately one out of three patients with CAD have significant symptoms of depression, which is an alarming finding for clinicians. Moreover, this study demonstrates a lack of sufficient depression recognition and management in similar study settings. Integration of mental health assessment and treatment among patients with CAD as soon as after PCI is recommended for optimal and effective treatment and to obtain the best outcomes.

Abstract Introduction The relentless COVID-19 pandemic caused a devastating sickness and loss of life at a global level. The stress related to the pandemic lockdown and near total paralysis of most human activities was associated with behavioral changes. It is largely unknown if these stresses could trigger acute cardiovascular events among non-infected individuals. Purpose To explore the relation between COVID-19 associated stresses and acute cardiovascular events among non-infected individuals. Methods Adult patients presented with acute myocardial infarction (AMI), stroke or out-of-hospital cardiac arrest (OHCA) at 11 hospitals in Jordan from March 2020 through February 2021 were assessed for potential exposure to stressful life events related to the COVID-19 pandemic. None of the patients was COVID-19 infected or a health care worker. Results Of 297 patients enrolled (mean age 58.4±13.1 years, 18.5% females), 267 patients (89.8%) had AMI, 15 patients (5.1%) had stroke, and 15 patients (5.1%) had OHCA. Cigarette smoking was present in 59.6%, hypertension in 50.5%, dyslipidemia in 42.8%, diabetes in 37.4%, and 35% had prior diagnosis of cardiovascular disease. Coronary revascularization was performed in 228 (85.4%) of AMI patients. In-hospital mortality among the AMI and stroke patients was 4.3% and none of the OHCA patients survived. The most common stresses preceded these events included financial hardships (50.8%), lockdown stress (25.9%), fears from the pandemic (24.9%), anger (22.6%), loneliness (19.2%), smoking binges (19.9%), death of a significant person (6.4%), and food binges (3.4%). Conclusions The COVID-19 pandemic and lockdown caused immense psychosocial and financial stresses that triggered life threatening acute cardiovascular events in non-infected individuals. Early recognition of stress-related symptoms during this unremitting pandemic warrants proper referral and evaluation. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): ABDEL HAMEED SHOMAN FOUNDATION (AHSF) RESEARCH FUND

Introduction and importance: Here we report a case of a middle-aged man who complained of blurred vision in his left eye 1 h post cardiac catheterization and proved to have central retinal artery occlusion, a dangerous but potentially treatable sight-threatening complication of cardiac-catheterization. The patient was successfully treated through an Ophthalmological surgical intervention. Case presentation: A 49- year-old male patient admitted to the coronary care unit as a case of non-ST-elevation-myocardial infarction. The patient underwent cardiac catheterization and stenting of the right coronary artery. One hour later, he complained of blurred vision in his left eye. Clinical discussion: Ophthalmological examination showed an inferior visual field defect in the left eye. Fundus fluorescein angiography revealed that the patient had a hemi-central retinal artery occlusion, a rare complication of cardiac catheterization. A pars plana vitrectomy eye surgery was performed with an excellent result. Conclusion: This case highlights the importance of early recognition and treatment of central retinal artery occlusion post cardiac catheterization

BACKGROUND:COVID-19 is an acute respiratory pandemic with no available effective antiviral treatment or widely available effective vaccine. Surgical practice has faced widespread problems due to the pandemic including viral transmission risk and cross-infection, staffing problems, prioritizations of surgical procedures, and lack of beds due to occupancy of hospitals and ICU beds with COVID-19 patients.METHODS:A survey was conducted between October 31 to November 4, 2020, through google forms. The questionnaire involved 16 questions sent to consultants and specialists of all general and special surgical specialties and subspecialties in Jordan.RESULTS:We have got responses from surgeons of all public and private sectors in Jordan. There was a pronounced decline in the number of elective and emergency procedures performed during October 2020 due to COVID-19 pandemic related reasons.CONCLUSIONS:The impact of COVID-19 on the surgical practice in Jordan during October 2020 was moderate to prominent. Measures that could be made to alleviate this impact include the assignment of certain hospitals for covid-19 patients as a step before the establishment of field hospitals and the cooperation between the private and the public health sectors.

The Corona Virus Disease 2019 (COVID-19) has become an unprecedented global public health crisis and a pandemic associated with vicarious psychosocial and economic stresses. Such stresses were reported to lead to behavioral and emotional disturbances in individuals not infected with the COVID-19 virus. It is largely unknown if these stresses can trigger acute cardiovascular events (CVE) in such individuals. Covid-19-neagtive adults presenting with acute myocardial infarction (AMI), cerebrovascular accident (CVA), or out-of-hospital cardiac arrest (OHCA) during the COVID-19 pandemic in Jordan from March 15, 2020 through March 14, 2021 were enrolled in the study if they reported exposure to psychosocial or economic stresses related to the pandemic lockdown. Of 300 patients enrolled (mean age 58.7 ± 12.9 years), AMI was diagnosed in 269 (89.7%) patients, CVA in 15 (5.0%) patients, and OHCA in 16 (5.3%) patients. Triggering events were psychosocial in 243 (81.0%) patients and economic stressors in 157 (52.3%) patients. The psychosocial stresses included loneliness, hopelessness, fear of COVID-19 infection, anger, and stress-related to death of a significant person. The economic stressors included financial hardships, job loss or insecurity, volatile or loss of income. Exposure to more than one trigger was reported in 213 (71.0%) patients. In-hospital mortality of the patients admitted for AMI or CVA was 2.1%, and none of the OHCA survived the event. The COVID-19 pandemic continues to be a source of significant psychosocial and economic hardships that can trigger life-threatening acute CVE among individuals not infected with the virus.