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

Alan M Batt
School of Medicine, Cardiff University
October, 2016


The aim was to evaluate the evidence base for pre-hospital 12-Lead electrocardiogram (ECG) acquisition, and pre-hospital percutaneous coronary intervention (PCI) activation and to evaluate the translation of this system of care 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 12-lead ECGs in the pre-hospital setting, although many of these studies focused on paramedic level clinicians. 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 Emergency Medical Technician (EMT) crews. Subsequent analysis of those who were identified as suffering a ST-segment Elevation Myocardial Infarction (STEMI) and who were brought for PCI at Sheikh Khalifa Speciality Hospital (SKSH) in RAK was also performed.
A total of 152 patients had a 12-lead ECG performed by EMTs in RAK, with 118 included for analysis after applying exclusion criteria. Mean patient age was 52.08 (SD+/- 19.46, range 19-97). There were 87 male (74%) and 31 female (26%) patients. A total of 29 patients had a confirmed STEMI and data was available for 16 who underwent PCI at SKSH. There was no mortality among the STEMI group, and no major adverse cardiac events were reported. The median door-to-balloon time was 73 minutes (range 48-586), and 75% of STEMI patients underwent angioplasty within 90 minutes of arrival. Discharge data was available for six patients at the time of analysis: all were discharged home with no impediments to rehabilitation and all were expected to have an improvement in functioning over time.
This study has demonstrated agreement with the existing evidence base for inclusion of pre-hospital ECG in the management of patients with ACS and pre-hospital PCI activation in the management of patients with STEMI. It has demonstrated that the establishment of an organised system of cardiac care which includes pre-hospital ECG acquisition and pre-hospital PCI activation is feasible in a novel population and clinical setting. It has also demonstrated a door-to-balloon time of under 90 minutes in 75% of STEMI patients, with no associated mortality or major adverse cardiac events.