title: Patient and System-Related Delays of Emergency Medical Services Use in Acute ST-Elevation Myocardial Infarction: Results from the Third Gulf Registry of Acute Coronary Events (Gulf RACE-3Ps).
abstract: BACKGROUND
  Little is known about Emergency Medical Services (EMS) use and pre-hospital triage of patients with acute ST-elevation myocardial infarction (STEMI) in Arabian Gulf countries.
  
  
  METHODS
  Clinical arrival and acute care within 24 h of STEMI symptom onset were compared between patients transferred by EMS (Red Crescent and Inter-Hospital) and those transferred by non-EMS means. Data were retrieved from a prospective registry of 36 hospitals in 6 Arabian Gulf countries, from January 2014 to January 2015.
  
  
  RESULTS
  We enrolled 2,928 patients; mean age, 52.7 (SD ±11.8) years; 90% men; and 61.7% non-Arabian Gulf citizens. Only 753 patients (25.7%) used EMS; which was mostly via Inter-Hospital EMS (22%) rather than direct transfer from the scene to the hospital by the Red Crescent (3.7%). Compared to the non-EMS group, the EMS group was more likely to arrive initially at a primary or secondary health care facility; thus, they had longer median symptom-onset-to-emergency department arrival times (218 vs. 158 min; p˂.001); they were more likely to receive primary percutaneous coronary interventions (62% vs. 40.5%, p = 0.02); they had shorter door-to-needle times (38 vs. 42 min; p = .04); and shorter door-to-balloon times (47 vs. 83 min; p˂.001). High EMS use was independently predicted mostly by primary/secondary school educational levels and low or moderate socioeconomic status. Low EMS use was predicted by a history of angina and history of percutaneous coronary intervention. The groups had similar in-hospital deaths and outcomes.
  
  
  CONCLUSIONS
  Most acute STEMI patients in the Arabian Gulf region did not use EMS services. Improving Red Crescent infrastructure, establishing integrated STEMI networks, and launching educational public campaigns are top health care system priorities.
authors.affiliation: Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Khalid F
authors.initials: KF
authors.lastname: AlHabib
authors.affiliation: Department of Cardiology, Royal Hospital, Muscat, Oman.
authors.forename: Kadhim
authors.initials: K
authors.lastname: Sulaiman
authors.affiliation: Department of Cardiology, Hamad Medical Corporation (HMC), Doha, Qatar.
authors.forename: Jassim
authors.initials: J
authors.lastname: Al Suwaidi
authors.affiliation: Heart and Vascular Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates.
authors.forename: Wael
authors.initials: W
authors.lastname: Almahmeed
authors.affiliation: College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.|Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates.|Tufts Clinical and Translational Science Institute, Tufts Medical Center, Boston, MA, United States of America.
authors.forename: Alawi A
authors.initials: AA
authors.lastname: Alsheikh-Ali
authors.affiliation: Mohammed Bin Khalifa Cardiac Center, Manama, Bahrain.
authors.forename: Haitham
authors.initials: H
authors.lastname: Amin
authors.affiliation: Sabah Al-Ahmed Cardiac Center, Kuwait, Kuwait.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al Jarallah
authors.affiliation: Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Hussam F
authors.initials: HF
authors.lastname: Alfaleh
authors.affiliation: Department of Cardiology, Royal Hospital, Muscat, Oman.
authors.forename: Prashanth
authors.initials: P
authors.lastname: Panduranga
authors.affiliation: Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Hersi
authors.affiliation: Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Tarek
authors.initials: T
authors.lastname: Kashour
authors.affiliation: Emergency Department, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Zohair
authors.initials: Z
authors.lastname: Al Aseri
authors.affiliation: Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Anhar
authors.initials: A
authors.lastname: Ullah
authors.affiliation: Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Hani B
authors.initials: HB
authors.lastname: Altaradi
authors.affiliation: Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia.
authors.forename: Kazi
authors.initials: K
authors.lastname: Nur Asfina
authors.affiliation: Division of Cardiology, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Welsh
authors.affiliation: Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Canada.
authors.forename: Salim
authors.initials: S
authors.lastname: Yusuf
mesh_terms: D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000188:drug therapy / Q000453:epidemiology; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D002317:Cardiovascular Agents / Q000627:therapeutic use; D004522:Educational Status; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D054242:Emigrants and Immigrants; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008877:Middle East / Q000453:epidemiology; D009203:Myocardial Infarction / Q000453:epidemiology / Q000601:surgery / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000706:statistics & numerical data; D011446:Prospective Studies; D012042:Registries; D012959:Socioeconomic Factors; D013997:Time Factors; D016896:Treatment Outcome; D014218:Triage
chemical_list: D002317:Cardiovascular Agents