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Multicenter Study
. 2025 Sep 2;20(9):e0331215.
doi: 10.1371/journal.pone.0331215. eCollection 2025.

The second survey of the Saudi Acute Myocardial Infarction Registry Program: Main results and temporal changes in care (STARS-2 program)

Ayman AlSaleh  1 , Shukri M AlSaif  2 , Osama Alhadramy  3   4 , Mohammed Alshehri  5 , Khalid Al Faraidy  6 , Fawaz Almutairi  7 , Abdulhalim J Kinsara  8 , Mushabab Al-Murayeh  9 , Abdullah E Ghabashi  10 , Mirvat Alasnag  11 , Gamal Abdin Hussein  12 , Tamer M Askar  13 , Kamel H Haider  14 , Ibrahim A Alharbi  14 , Abdulaziz Almokhlef  15 , Belal A Sayed  16 , Adel Almasswary  17 , Zia- Ul-Sabah  18   19 , Hameedullah Kazim  20 , Hazem A Albareda  21 , Mubarak A Aldossari  22 , Rasha Albawardi  8 , Rudaynah Alali  23 , Ibrahim A M Abdulhabeeb  24 , Saifeldin Mohamed Ibrahim  25 , Sami Alasmari  26 , Abdulrahman M Almoghairi  27 , Abdullateef Y Khoja  28 , Naveed Hussain  29 , Balarabe S Aminu  30 , Abdulhalim Serafi  31 , Abdalla Osman Eltayeb  32 , Ali Husain BuSaleh  33 , Basel Alsabatien  34 , Mirghani K Hamza  35 , Rasha Alsharkawy  36 , Awatif A Awwad  37 , Maha A Mohamed  38 , Mohammed A Al Habeeb  39 , Syed Shujauddin  40 , Jamila Ado Ya'u  41 , Nashwa M Attia  42 , Naji Kholaif  43 , Nazeeh M Bin Ghouth  44 , M Kheir I Youssef  45 , Mohammed A Qutub  46 , Samih R Lawand  47 , Raed Alkutshan  48 , Emadaldein Ahmed  1 , Ayman Basardah  1 , Wasem I Alhaj  49 , Hani Altaradi  50 , Muhammad Ali  51 , Wael Alqarawi  1   52 , Khalid F Alhabib  1 ; STARS-2 Investigators
Affiliations
Multicenter Study

The second survey of the Saudi Acute Myocardial Infarction Registry Program: Main results and temporal changes in care (STARS-2 program)

Ayman AlSaleh et al. PLoS One. .

Abstract

Background: The Saudi Acute Myocardial Infarction Registry (STARS) program aims to evaluate the clinical characteristics, management, and outcomes of a representative sample of patients with acute myocardial infarction (AMI) in Saudi Arabia. This second phase evaluates temporal changes in patient care, demographics, and the management benchmarks for AMI.

Methods and findings: We created a 5-year recurring, multi-center prospective registry that utilizes a snapshot design in 50 hospitals from various healthcare sectors in Saudi Arabia. The study's recruitment phase spanned from September 3, 2021, to January 6, 2023. During these 16 months, 2,690 patients presenting with acute myocardial infarction (AMI) with or without ST-segment elevation (STEMI or NSTEMI, respectively) were enrolled. The mean age (± SD) of the overall population was 57 (±12.4) years, 70% were Saudi citizens, 82% were men, and (48.8%) of the total patients had STEMI. Fifty-eight percent of patients had diabetes mellitus and 58% had hypertension. Of the total population with STEMI, primary percutaneous coronary intervention (PCI) was performed in 619 patients (47.1%), thrombolytics were given to 584 patients (44.5%), and 110 patients had no reperfusion (8.4%). Among patients who presented within 24 h of symptom onset, the door-to-balloon (DTB) time was 63 min (IQR: 43), with 75.6% achieving DTB < 90 min, whereas the door-to-needle (DTN) was 25 min (IQR: 34), with 57% achieving DTN < 60 min. Thirty-nine percent of patients failed lytic reperfusion and 96% of these required rescue PCI. In 52% of instances, the failure to receive reperfusion therapy was attributed to patients' late presentation. At presentation, only 8.5% of cases were transferred by the Emergency Medical Services. Approximately one-fourth of patients with NSTEMI did not undergo a coronary angiogram. All-cause mortality was 2.4% with no significant difference between sexes or nationalities.

Conclusion: This nationwide AMI registry revealed younger age at presentation with a high prevalence of risk factors for coronary artery disease. While primary PCI key performance indicators have improved from the previous phase, further progress is needed in EMS utilization and acute revascularization for STEMI and NSTEMI.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Timeline of patients with ST-segment elevation myocardial infarction who had FMC. The total ischemic time (TIT)/primary PCI 285 min (IQR: 274). The total ischemic time (TIT)/thrombolytics 278 min (IQR: 142). TT: Thrombolytic Time; ED: Emergency Department; PCI: Percutaneous Coronary Intervention; FMC: First Medical Contact.
Fig 2
Fig 2. Timeline of patients with ST-segment elevation myocardial infarction who are self-presented.
The Total Ischemic Time (TIT)/primary PCI 220 min (IQR: 250). The Total Ischemic Time (TIT)/thrombolytics 300 min (IQR: 400). TT: Thrombolytic Time; ED: Emergency Department; PCI: Percutaneous Coronary Intervention; FMC: First Medical Contact.
Fig 3
Fig 3. STEMI presented within 24 hrs.
DTN: Door To Needle Time. DTB: Door To Balloon Time.
Fig 4
Fig 4. Medication upon the first 24 hours of hospital admission. STEMI: ST-elevation myocardial infarction; NSTEMI: non-ST-elevation myocardial infarction. ACE-I: Angiotensin-Converting Enzyme Inhibitors; ARB: Angiotensin II Receptor Blockers.
Fig 5
Fig 5. Medication upon discharge.
STEMI: ST-elevation myocardial infarction; NSTEMI: non-ST-elevation myocardial infarction. ACE-I: Angiotensin-Converting Enzyme Inhibitors; ARB: Angiotensin II Receptor Blockers.
See this image and copyright information in PMC

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