title: Impact of access to hospitals with catheterization facilities in the second Gulf Registry of Acute Coronary Events (Gulf RACE-2).
abstract: OBJECTIVE
  It is currently unclear whether acute coronary syndrome patients who access hospitals with catheterization facilities, with or without an on-site percutaneous coronary intervention (PCI), have better outcomes in real-life clinical practice.
  
  
  RESULTS
  This 9-month prospective study was carried out in six Arabian Gulf countries. Patients in hospitals with catheterization facilities [20/65 hospitals; 3615/6847 (52.8%) patients] were more likely to show evidence of cardiovascular risk factors (P<0.001) and more likely to undergo revascularization procedures that were mostly performed (≥80%) in low-risk and intermediate-risk patients. Patients in these centres experienced significantly higher rates of medical therapies and shorter door-to-needle times [median (IQR): 33 (40) vs. 43.5 (43) min, P<0.001]; 14.1% had primary PCI. They also had less in-hospital recurrent ischaemia, recurrent myocardial infarction, congestive heart failure and stroke, but more cardiogenic shock and major bleeding, and they had similar adjusted mortality rates in-hospital [odds ratio (OR): 1.06, 95% confidence interval (CI): 0.88-1.27] and at 30-day (OR: 1.11, 95% CI: 0.91-1.36) and 1-year (OR: 1.06, 95% CI: 0.89-1.27) follow-ups.
  
  
  CONCLUSIONS
  Access to hospitals with catheterization facilities, with or without on-site PCI, was associated with a reduction in recurrent myocardial infarction and recurrent ischaemia, but not mortality. Further efforts are required to target revascularization procedures for higher risk patients as well as to widely implement primary PCI programmes.
authors: King Fahad Cardiac Center, King Khalid University Hospital, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia. khalidalhabib13@hotmail.com
authors: Khalid F
authors: KF
authors: Alhabib
authors: Sanjit S
authors: SS
authors: Jolly
authors: Salim
authors: S
authors: Yusuf
authors: Alawi A
authors: AA
authors: Alsheikh-Ali
authors: Jassim
authors: J
authors: Al Suwaidi
authors: Ahmad
authors: A
authors: Hersi
authors: Kadhim
authors: K
authors: Sulaiman
authors: Shukri
authors: S
authors: Al Saif
authors: Wael
authors: W
authors: Almahmeed
authors: Nidal
authors: N
authors: Asaad
authors: Haitham
authors: H
authors: Amin
authors: Ahmed
authors: A
authors: Al-Motarreb
authors: Hussam
authors: H
authors: Alfaleh
authors: Khalid
authors: K
authors: Alnemer
authors: Lukman
authors: L
authors: Thalib
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D005260:Female; D006297:Health Services Accessibility; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D015397:Program Evaluation; D011446:Prospective Studies; D012008:Recurrence; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome