Quality of care in primary percutaneous coronary intervention for acute ST-segment-elevation myocardial infarction: Gulf RACE 2 experience

Abstract

BACKGROUND AND OBJECTIVES: Primary percutaneous coronary intervention (pPCI) has been recognized as an effective management strategy for acute ST-segment–elevation myocardial infarction (STEMI). However, there is no first-hand information regarding the quality of pPCI procedures in the Arabian Gulf countries. This study aims to explore the quality of pPCI practice. DESIGN AND SETTINGS: The Gulf Race II was designed as a prospective, multinational, multicentre registry of acute coronary events, focusing on the epidemiology, management practices, and outcomes of patients with acute coronary syndrome. The study recruited consecutive patients aged 18 years and above from 65 hospitals in 6 adjacent Middle Eastern countries (Bahrain, Saudi Arabia, Qatar, Oman, United Arab Emirates, and Yemen). PATIENTS AND METHODS: We used data from the Gulf Registry of Acute Coronary Events (Gulf RACE 2). We analyzed data on patients who received pPCI to assess the guidelines-supported performance measure of door-to-balloon (D2B) ≤ 90 minutes and its impact on morbidity and mortality. RESULTS: Of 3432 patients with STEMI, slightly more than half (53%, n=1832) were admitted to a hospital with a cardiac catheterization laboratory (Cath-Lab). Of these, only 1006 patients (55%) received reperfusion therapy, and pPCI was used in a small predominantly male subgroup (11% of the STEMI cohort admitted to hospitals with Cath-Lab, n=198). The median D2B time in the pPCI cohort was 85 minutes, and a D2B of ≤90 minutes was achieved in only 55%. Patients with timely pPCI (D2B ≤ 90 minutes) were less likely to have cardiogenic shock and require intra-aortic balloon pump. In-hospital, 1-month and 1-year mortality were not statistically in favor of timely pPCI. CONCLUSION: Primary PCI was underused in the Gulf region with low rate of acute reperfusion and no timely pPCI and thus no mortality benefit.