Implementation of an ST-segment elevation myocardial infarction bypass protocol in the Northern United Arab Emirates
Alan M Batt1, Ahmed S Al-Hajeri2, Shannon Delport3, Sue M Jenkins4, Sharon E Norman4, Fergal H Cummins5
1 National Ambulance, Abu Dhabi, UAE; CQ University, Rockhampton, Australia; Fanshawe College, Ontario, Canada; Retrieval, Emergency and Disaster Medicine Research and Development Unit, University Hospital Limerick, Ireland
2 National Ambulance, Abu Dhabi, UAE
3 National Ambulance, Abu Dhabi, UAE; CQ University, Rockhampton, Australia
4 Cardiff University, Wales, UK
5 National Ambulance, Abu Dhabi, UAE; Retrieval, Emergency and Disaster Medicine Research and Development Unit, University Hospital Limerick, Ireland; Charles Sturt University, Bathurst, Australia; Graduate Entry Medical School, University of Limerick, Ireland
Mr. Alan M Batt
Etihad Towers, Level 6 Tower 3, Abu Dhabi, United Arab Emirates
Source of Support: None, Conflict of Interest: None
Objective: The aim was to evaluate the translation of an ST-segment elevation myocardial infarction (STEMI) bypass protocol to the outcomes of patients with acute coronary syndrome in the Emirate of Ras al-Khaimah in the United Arab Emirates (UAE).
Methods: A prospective cohort study was conducted, which included all patients who had a prehospital 12-lead electrocardiogram (ECG) performed by ambulance crews. Analysis of those who were identified as having STEMI and who subsequently underwent percutaneous coronary intervention (PCI) was performed.
Results: A total of 152 patients had a 12-lead ECG performed during the pilot study period (February 24, 2016–August 31, 2016) with 118 included for analysis. Mean patient age was 52 years. There were 87 male (74%) and 31 female (26%) patients. Twenty-nine patients suffered a STEMI, and data were available for 11 who underwent PCI. There was no mortality, and no major adverse cardiac events were reported. The median door-to-balloon (D2B) time was 73 min (range 48–124), and 81% of patients had a D2B time < 90 min. Discharge data were available for six patients: All were discharged home with no impediments to rehabilitation.
Conclusion: This pilot study has demonstrated agreement with the existing literature surrounding prehospital ECG and PCI activation in an unstudied STEMI population and in a novel clinical setting. It has demonstrated a D2B time of < 90 min in over 80% of STEMI patients, and a faster mean D2B time than self-presentations (mean 77 min vs. 113 min), with no associated mortality or major adverse cardiac events.