Background. Khat chewing is a common habit in Yemen despite increased evidence of its negative impact on the cardiovascular system. Aims. We aimed to study the epicardial coronary arteries in khat chewers presenting with myocardial infarction (AMI). Materials and Methods. A descriptive, cross-sectional study was conducted between November 2008 and May 2009 in Yemen. AMI patients who underwent coronary angiogram were enrolled and divided into groups (gp): gp1 (diabetic and khat chewers), gp2 (khat chewers and nondiabetic), and gp3 (diabetic and non-khat users). Results. Of 347 AMI patients 63%, 21%, and 16% were in gp 2, 3, and 1, respectively. Khat chewers were younger in comparison to non-khat users. Group 3 patients were more likely to have multivessel disease, severe left anterior descending (LAD), right coronary artery (RCA) stenosis and total RCA, and left circumflex (Lcx) occlusion compared to other groups. Group 1 patients were more likely to have total LAD occlusion and severe Lcx lesions. In multivariate analysis, age, diabetes mellitus, and smoking were significant independent predictors for significant coronary artery lesions; however, khat chewing did not show such association. Conclusions. Coronary spasm is the main mechanism of AMI in khat chewers. The impact of our finding for risk stratification and management warrants further studies. 1. Introduction Khat (Catha edulis) is a flowering plant native to the Horn of Africa and the Arabian Peninsula [1]. In countries from these areas, “khat parties” have been accepted for decades as part of formal social customs [2]. Khat was initially thought to be a nonsignificant problem to Western populations; however, international delivery systems and immigration of khat chewers contributed to its large-scale distribution. Moreover, new synthetic forms are being developed, including Hagigat, Rakefet, Mephedrone, and Graba [3]. Users chew this stimulant habitually in groups, for its euphoric effects and as a recreational drug. Chewing khat is both a social and a culture-based activity. It is said to enhance social interaction, playing a role in ceremonies such as weddings [1, 2, 4, 5]. In Yemen, there are about 44 different types of khat from different geographic areas of the country. Its taste varies from one kind to another and depends on the tannic acid content. Khat leaves have an astringent taste and have an aromatic odor. The young leaves are slightly sweet [6, 7] (Figure 1). Figure 1: Khat tree and how khat users chew and keep it for few hours in their mouth cavity. In 1980, the World Health
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