SHA24/041003

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