Feasibility of Developing Emergency Medical Services (EMS) Registry and Exploring the benefits of using EMS among Arabian Gulf patients presenting with ST elevation myocardial infarction (STEMI). Data analysis and interpretation thesis of the RACE III registry (Gulf Registry of Acute Coronary Events: Primary PCI programs).

Abstract

Abstract

Background Practice guidelines strongly recommend the activation of emergency medical services (EMS) by patients with symptoms consistent with acute myocardial infarction (AMI). Little is known about the EMS usage by patients with ST elevation myocardial infarction (STEMI) in the Arabian Gulf region. We explored the feasibility of developing an EMS registry and the benefits of EMS use among Arabian Gulf patients presenting with STEMI. Objective For Arabian Gulf patients presenting with STEMI and enrolled in the Gulf Registry of Acute Coronary Events: Primary PCI programs (RACE III registry), how feasible and suitable the registry data are in terms of data completeness and an appropriate recruitment time interval (primary objective). Once the primary outcome is fulfilled, the secondary objective will be explored—namely, whether the use of EMS improves the provision of timely care, defined as door-to-balloon time <90 minutes or door-to-needle time < 30 minutes, or other clinical outcomes. Methods Analysis and interpretation of the RACE III registry were done by assessing data set completeness and exploring if EMS improved the provision of timely care or other clinical outcomes. We evaluated 574 STEMI patients recruited between May 2013 and May 2014 in six Arabian Gulf countries.

Results For the primary outcome, we found that the study was feasible as only 0.7% of the variables of interest were missing and all patients were recruited over a one-year period. For the secondary outcome, EMS use was associated with the better delivery of timely care (EMS used 75.2% vs. EMS not used 49.7%; p<.001). The adjusted odds ratio for EMS use was 1.81(%95CI: 1.11, 2.96), suggesting that patients using EMS received timely care 1.8 times more than patients who not using EMS. EMS use was also associated with a lower risk for recurrent MI and hospital death compared to non-EMS use; adjusted OR was 0.29 (95%CI: 0.1, 0.87) for recurrent MI when EMS was used and OR was 0.26 (95%CI: 0.09, 0.81) for hospital deaths when EMS was used. Conclusion Our study demonstrated the feasibility of the RACE III registry to evaluate EMS use among Arabian Gulf patients presenting with STEMI. EMS use was associated with better timely care and improved clinical outcomes. Caution should be exercised in interpreting these finding due to the low number of study participants and the registry nature of the data.