Trends in characteristics and outcomes following primary percutaneous coronary intervention: insights from a...

Primary percutaneous coronary intervention (PPCI) is the standard of care for ST-segment elevation myocardial infarction (STEMI). Yet, data from the Middle East on long-term national trends in procedural characteristics and outcomes remain limited. This study aimed to evaluate nationwide trends in PPCI for STEMI in Qatar over nine years (2015-2023), analyzing trends of cardiovascular risk factors, presentation management, and in-hospital outcomes of STEMI cases treated with PPCI in Qatar.

We examined 7,959 STEMI patients who underwent PPCI at Qatar Heart Hospital between 2015 and 2023. Descriptive statistics were presented as mean ± SD or proportions. One-way ANOVA and chi-square tests were used to assess temporal trends. Multivariate logistic regression identified risk factors associated with in-hospital mortality. A p-value ≤ 0.05 was considered significant.

Annual PPCI volume increased > 50% from 820 cases in 2015 to 1,264 in 2023. The mean age was 49 years, predominantly male and non-Qatari. Cardiovascular risk factors increased significantly throughout the study, while EMS utilization rose from 63% to 77%. Radial access use increased from 57% to 84%, and intravascular ultrasound from 1.4% to 10%. Door-to-balloon time at the PPCI center declined from 60 to 45 min (p = 0.001). In-hospital mortality decreased from 4.4% in 2016 to 1.5% in 2023 (p < 0.001). Predictors of in-hospital mortality included older age (OR 1.03, 95% CI 1.01-1.04), prolonged door-to-balloon time 71-80 min: OR 3.49, 95% CI 1.35-9.05; 81-90 min: OR 3.01, 95% CI 1.06-8.60; ≥91 min: OR 3.31, 95% CI 1.36-8.08), cardiogenic shock requiring IABP (OR 12.08, 95% CI 8.30-17.60), and cardiac arrest (OR 4.76, 95% CI 3.04-7.49).

This nine-year national PPCI registry demonstrates substantial improvements in access, procedural practice, and efficiency of STEMI care in Qatar, with marked decline in in-hospital mortality.