Primary coronary angioplasty for ST-Elevation Myocardial Infarction in Qatar: First nationwide program

Abstract

In this article, we outline the plans, protocols and strategies to set up the first nationwide primary Percutaneous Coronary Intervention (PCI) program for ST-elevation myocardial Infarction (STEMI) in Qatar, as well as the difficulties and the multi-disciplinary solutions that we adopted in preparation. We will also report some of the landmark literature that guided our plans. The guidelines underscore the need for adequate number of procedures to justify establishing a primary-PCI service and maintain competency. The number of both diagnostic and interventional procedures in our centre has increased substantially over the years. The number of diagnostic procedures has increased from 1470 in 2007, to 2200 in 2009 and is projected to exceed 3000 by the end of 2012. The total number of PCIs has also increased from 443 in 2007, to 646 in 2009 and 1176 in 2011 and is expected to exceed 1400 by the end of 2012. These figures qualify our centre to be classified as ‘high volume’, both for the institution and for the individual interventional operators. The initial number of expected primary PCI procedures will be in excess of 600 procedures per year. Guidelines also emphasize the door to balloon time (DBT), which should not exceed 90 minutes. This interval mainly represents in-hospital delay and reflects the efficiency of the hospital system in the rapid recognition and transfer of the STEMI patient to the catheterization laboratory for primary-PCI. Although DBT is clearly important and is in the forefront of planning for the wide primary PCI program, it is not the only important time interval. Myocardial necrosis begins before the patient arrives to the hospital and even before first medical contact, so time is of the essence. Therefore, our primary PCI program includes a nationwide awareness program for both the population and health care professionals to reduce the pre-hospital delay. We have also taken steps to improve the pre-hospital diagnosis of STEMI. In addition to equipping all ambulances to perform 12-lead electrocardiograms (ECGs) we will establish advanced wireless transmission of the ECG to our Heart Centre and to the smart phone of the consultant on-call for the primary-PCI service. This will ensure that the patient is transferred directly to the cath lab without unnecessary delay in the emergency rooms. A single phone-call system will allow the first medic making the diagnosis to activate the primary PCI team. The emergency medical system is acquiring capability to track the exact position of each ambulance using GPS technology to give an accurate estimate of the time needed to arrive to the patient and/or to the hospital. We also plan for medical helicopter evacuation from remote or inaccessible areas. A comprehensive research database is being established to enable specific pioneering research projects and clinical trials, either as a single centre or in collaboration with other regional or international centers. The primary-PCI program is a collaborative effort between the Heart Hospital, ...

ST‐elevation myocardial infarction in a migrant population: a registry‐based study of patient treatment and outcomes

“…Patients of Asian, Middle Eastern and Pacific Islander background emerged as relatively higher risk groups within the migrant cohort, exhibiting a greater risk factor burden, higher troponin values, more advanced disease on angiography and higher rates of impaired LVEF post‐STEMI. Given the small group sizes, these findings should be interpreted with caution; however, our results are consistent with international studies and warrant further investigation.…”

Mortality Trends in Patients Hospitalized with the Initial Acute Myocardial Infarction in a Middle Eastern Country over 20 Years

“…Moreover, the hospital stay is expected to decrease further with a full implementation of the recent primary PCI program in Qatar [43]. …”

RENASICA II: A Mexican acute myocardial infarction registry that highlights the importance of regional registries

“…Findings from Gulf RACE and Gulf RACE-2 resulted in changing practice for STEMI patients in Qatar. Countrywide primary PPCI (24 hours service) in Qatar, 6 which was launched in October 2013 and so far it is the main modality of reperfusion therapy (>99% of STEMI patients), further highlighting the importance of conducting regional registries for quality improvement.…”