Abstract

Background: ST-Elevation Myocardial Infarction (STEMI) is a life-threatening condition that requires immediate intervention to minimize mortality and complications. Timely diagnosis and treatment are critical because delay in intervention increases the one-year mortality risk. While Percutaneous Coronary Intervention (PCI) is the gold standard treatment, its availability is limited to PCI-capable hospitals, making it essential to rapid stabilization and transfer from non-PCI hospitals. Adherence to time-sensitive benchmarks, such as Door-to-ECG, Door-In-Door-Out (DIDO), and transport times, is crucial for achieving optimal outcomes and aligning with international guidelines.

Objective: This study assesses compliance with essential STEMI management benchmarks, such as Door-to-ECG, Door-In-Door-Out (DIDO), and Door-Out to Arrival times at Ibrahim Bin Hamad Obaidallah Hospital over 12 months. It also seeks to identify adherence patterns and reasons for delays in a facility without PCI capabilities.

Methods: A retrospective analysis of hospital records occurred over 12 months(2024) at Ibrahim Bin Hamad Obaidallah Hospital (IBHOH). We included adult patients (aged 18 years and older) who had a Code MI activation due to suspected STEMI while excluding those without Code MI activation or with other diagnoses. Data was categorized by month and verified against various hospital records for accuracy. Key metrics evaluated included Door-to-ECG time (<10 minutes), Door-In-Door-Out time (30–40 minutes), and Door-Out to Arrival time at Sheikh Khalifa Specialized Hospital(SKSH) (<40 minutes). Findings were summarized using descriptive statistics, covering percentages and averages. The study follows ethical standards to protect patient confidentiality by using aggregated data that lacks personal identifiers.

Results: Over 12 months, 99 Code MI activations occurred. Compliance with the Door-to-ECG benchmark (<10 minutes) exceeded the target of 70% in all months, achieving 100% compliance in six out of twelve months. The lowest compliance rate was observed in May (75%). DIDO compliance was achieved in eight months (100%), but dropped to 50% in May and 85.7% in August due to coordination delays and atypical presentations. Door-out to Arrival times consistently met the hospital target (<40 minutes), with average transport times between 25 and 30 minutes.
Conclusion: This study highlights adherence to Door-to-ECG benchmarks at IBHOH and identifies common delay factors impacting DIDO compliance. Findings underscore the need for contingency protocols to manage delays caused by atypical presentations and PCI center capacity, supporting efforts to improve STEMI care standards in non-PCI hospitals.