Please fill the very end of the EMS section for the pts who transferred to you after receiving thrombolytics to outside of your hospital.  INCLUDE: STEMI patients who presented to your hospital from the community, clinics, or stopped transiently UP TO 24 HOURS at the Emergency Department of another hospital.
Gulf Registry of Acute Coronary Events
Primary PCI has been shown to be superior to thrombolytic therapy for the treatment of patients with STEMI when done within 90-120 minutes of hospital arrival. Several studies have demonstrated the benefit on clinical outcomes of establishing Primary PCI programs whereby patients with STEMI bypass even nearby local hospitals and get directly transferred to a Cath Lab hospital. Le May et al from the University of Ottawa Heart Institute have shown recently a reduction in the in-hospital and long-term mortality rates by using such system (JACC. 60 (14); 1223-30, 2012). A major initiative lead by the ESC and EAPCI called “Stent for Life” has been launched few years ago in order to increase the penetration of Primary PCI and showed marked variability in the treatment of such patients in several countries in Europe.

There are several components that play a major role in any Primary PCI program; including: public awareness of symptoms and EMS services, infrastructure of the transportation system, access of patients to the health care system, availability of an efficient and effective EMS, competent Cath Lab staff, high-volume PCI hospital, and logistic support of the health care system and hospital administration. Data from the Gulf RACE and Gulf RACE-2 of almost 16,000 ACS patients in total showed that only 20% use the EMS to arrive to the hospital. This low rate of use might be related to low trust of the public in the EMS because of underdeveloped EMS capabilities and services, and/or lack of awareness of EMS services, and/or low health awareness of the public. Undeveloped and crowded traffic systems in the Gulf region and/or low health awareness result in the long time spent from symptom onset to hospital arrival of AMI patients in the Gulf region (median time 240 minutes). There are some hospitals in the Arab Gulf region that have started a 24/7 Primary PCI program in the last few years. However, the rate of Primary PCI in Gulf RACE-2 was low (22%), and was also likely an overestimated rate since the majority (70%) of the hospitals in the registry weretertiary care hospitals.
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