The impact of an organised system of cardiac care on patient outcomes in the Emirate of Ras al-Khaimah, United Arab Emirates

Batt, AM ORCiD: 0000-0001-6473-5397The aim was to evaluate the evidence for pre-hospital 12-Lead electrocardiogram (ECG) acquisition, and percutaneous coronary intervention (PCI) activation and to evaluate the translation of this system to the outcomes of patients with acute coronary syndrome (ACS) in the Emirate of Ras al-Khaimah (RAK), in the United Arab Emirates (UAE). Literature review A review of the literature revealed good evidence for the acquisition and interpretation of pre-hospital 12-lead ECGs. Good evidence was also found for PCI activation based on pre-hospital 12-lead ECGs. Patients and methods A prospective cohort study was conducted, which included all patients who had a 12-lead ECG performed by National Ambulance crews. Subsequent analysis of those who were identified as suffering a ST-segment Elevation Myocardial Infarction (STEMI) and who underwent PCI was performed. Results A total of 152 patients had a 12-lead ECG performed, 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 was available for 16 who underwent PCI. There was no mortality and no major adverse cardiac events were reported. The median door-to-balloon time was 73 minutes (range 48-586), and 75% of patients had a door-to-balloon time <90 minutes. Discharge data was available for six patients: all were discharged home with no impediments to rehabilitation. Conclusion This study has demonstrated agreement with the existing literature surrounding pre-hospital ECG and PCI activation in the management of STEMI. It has demonstrated that the establishment of an organised system of cardiac care is feasible in a novel population and clinical setting. It has demonstrated a door-to-balloon time of