Khalid F. AlHabib. MBBS.FRCPC.FACC President of the Saudi Heart Association Associate Professor of Medicine Interventional Cardiology Consultant King Fahad Cardiac Center, King Saud University Riyadh, Saudi Arabia
OUTLINE • What did we learn from Gulf RACE-2 (especially STEMI care)? • How do we compare to the contemporary international data? • Gulf RACE-3Ps: could we establish Primary PCI Programs for STEMI patients in the Arab Gulf region?
Country
Enrolled Hospitals 14
Tertiary Care Hospital 12
Cath. Lab. Facilities 11
YEMEN
29
29
11
BAHRAIN
1
1
1
UAE
4
2
3
OMAN
16
1
1
QATAR
2
1
1
KSA
# of patients
Mean age
DM
STEMI
NSTEACS
Symptoms onset to hospital arrival (min)
(years) NRMI
2,515,106
65-70
17-35%
47%
53%
132 to 96
GRACE
102,341
63-69
20-30%
30-40%
60-70%
140 to 120
GRACE 2
31,982
65
26%
30%
70%
133
EHS 1, 2
16,183
63
21-27%
42-47%
48-51%
170 to 145
CREATE
20,937
57
30%
61%
39%
300
Gulf RACE
8,176
56
40%
39%
61%
N/A
Gulf RACE-2
7,930
56
48%
46%
54%
178
SPACE
5,062
58
58%
41%
59%
150
PPCI
DNT
TT
(min) NRMI
2.6 to 43%
59 to 29
GRACE
15 to 44%
40 to 30
GRACE 2
52 to 28% 41 to 16%
16%
32
33%
EHS 1, 2
40 to 58%
40 to 37
CREATE
8%
50
59%
Gulf RACE Gulf RACE-2 SPACE
8%
45
82%
22%
39
17.5%
52
37 to 41%
In-hospital mortality (STEMI/ NSTEACS)
30-day
12-month mortality
mortality
8%/5.2%
N/A
N/A
5.4%/2%
8%/3%
14.8%
6.2%/4.6%
N/A
N/A
5.3%/2.5%
6.4%/3.4%
7%/5%
5.6%
8.6%/3.8%
N/A
6.2%/1.9%
N/A
N/A
66%
7%/2.5%
9.8/5%
11.5/7.7
69%
4.5%/2%
N/A
N/A
Puymirat et al, JAMA. online 27 August 2012
1 in 5 use EMS
Fares et al, J Emerg Med, 2011 Sep; 41 (3): 310-6
Fares et al, J Emerg Med, 2011 Sep; 41 (3): 310-6
Fares et al, J Emerg Med, 2011 Sep; 41 (3): 310-6
EMS (%)
No EMS (%)
Unadjusted OR
Adjusted OR (95% CI)
(95% CI) In hospital ischemia In hospital In hospital In hospital shock In hospital
Recurrent
13.5
17.1
0.75 (0.63 – 0.90)
0.78 (0.65 – 0.94)
Recurrent MI CHF cardiogenic
1.8
2.3
0.79 (0.51 – 1.23)
0.91 (0.57 – 1.43)
15.1
13.5
1.14 (0.96 – 1.35)
1.20 (0.99 – 1.45)
6.0
6.3
0.94 (0.73 – 1.21)
1.10 (0.83 – 1.44)
stroke
0.8
0.7
1.14 (0.58 – 2.22)
1.02 (0.48 – 2.17)
In hospital major bleeding
0.5
0.6
0.90 (0.40 – 2.04)
0.68 (0.26 – 1.77)
In hospital mortality Mortality 1 month Mortality 1 year
4.8
4.85
1.07 (0.81 – 1.41)
1.18 (0.86 – 1.60)
7.4
8.6
0.85 (0.67 – 1.08)
0.92 (0.71 – 1.19)
13.1
12.9
1.02 (0.83 – 1.26)
1.05 (0.83 – 1.31)
AlHabib et al, in press
Le May et al, JACC. 60 (14); 1223-30, 2012
Gulf RACE-3Ps Primary PCI Programs with direct EMS referral of STEMI patients to PCI centers Primary PCI Centers
* Main Objective It is a quality improvement initiative is to establish timely acute reperfusion therapy, and in particularly Primary PCI Programs in order to improve care of STEMI patients in the Arabian Gulf countries.
* Main Goals:
The current status of EMS services in ACS care Mode of transportation and processes of care in the ED Delay in presentation
1. 1. Under Under which which authority? authority? 2. 2. EMS EMS crew crew details? details? 3. 3. EMS EMS response response time-lines? time-lines? 4. 4. Scene Scene details? details? 5. 5. Clinical Clinical presentation? presentation? 6. EMS work-up/management? 7. 7. ED ED work-up/management? work-up/management? 8. 8. STEMI STEMI timelines timelines in in ED? ED? 9. 9. Final Final diagnosis? diagnosis? 10. 10. Outcomes? Outcomes?
EMS
Is there a Gulf Metabolic Syndrome? : Oil wealth-induced “OBESOGENIC URBANISATION”!! Guy GW, et al. IJDM, April 2009
You see things and you say, “Why”?; but I dream things that never were and I say, “Why not?” George Bernard Shaw THANK YOU