# Evaluating the Impact of the Saudi Model of Care ST-Elevation Myocardial Infarction (STEMI) Pathway on Interfacility Communication Between a PCI-Capable Center and Referring Hospitals in the Qassim Region, Saudi Arabia

## TL;DR

This study shows that a regional STEMI care pathway in Saudi Arabia improved transfer times between hospitals, leading to faster treatment for heart attack patients.

## Contribution

The study evaluates the impact of the Saudi Model of Care STEMI pathway on interfacility communication and transfer times in the Qassim region.

## Key findings

- STEMI referrals increased from 312 in 2023 to 392 in 2024, showing greater pathway utilization.
- Median DIDO time improved from 48 minutes in 2023 to 35 minutes in 2024, nearing the 30-minute benchmark.
- Median D2B time decreased from 118 minutes in 2023 to 99 minutes in 2024, remaining within the 120-minute target.

## Abstract

Background: Timely reperfusion is critical in ST-elevation myocardial infarction (STEMI), especially when patients initially present to hospitals without percutaneous coronary intervention (PCI) capability. Door-to-balloon (D2B) time and door-in-door-out (DIDO) time are very vital for the clinical outcome of the STEMI patients. The STEMI Pathway, implemented under the Saudi Model of Care (SMoC), is a regional initiative to streamline interfacility communication and transfers between 16 hospitals (including one PCI-capable center) in the Qassim region of Saudi Arabia. Operated by Prince Sultan Cardiac Center Qassim (PSCCQ), the pathway is coordinated and supported by the Qassim Health Cluster as part of its ongoing efforts to enhance acute cardiac care services.

Aim: This study aims to assess the DIDO and D2B time for STEMI patients reported to PSCCQ in 2023 and 2024.

Methods: A retrospective study was conducted in March 2025 using data from STEMI cases transferred from non-PCI hospitals in Qassim province to the sole PCI center (PSCCQ) during 2023 and 2024. Important information recorded was arrival (door-in) at the receiving hospital, departure from the referring hospital (door-out), and balloon inflation time at the receiving hospital. From these, DIDO time (time of transfer out from a non-PCI facility to time of arrival at the referral hospital) and overall D2B time (from referral hospital arrival to PCI balloon inflation) were calculated.

Results: STEMI interfacility referrals increased from 312 in 2023 to 392 in 2024, indicating expanded utilization of the pathway. The DIDO time improved markedly from a median of 48 minutes in 2023 to 35 minutes in 2024. Likewise, median D2B decreased from 118 minutes in 2023 to 99 minutes in 2024. These improvements brought the median DIDO time closer to the recommended benchmark (≤30 minutes), while the median D2B time, which was already within the recommended ≤120 minutes in both 2023 and 2024, showed further improvement in 2024.

Conclusion: Implementation of the SMoC STEMI pathway was associated with significantly enhanced interfacility communication and expedited transfers. Specifically, DIDO improved significantly in 2024 and approached the international benchmark of ≤30 minutes. Median D2B times, already within the recommended ≤120 minutes in 2023, showed further improvement in 2024, directly corresponding to the improved DIDO times. These findings underscore the value of coordinated regional STEMI networks in optimizing time-sensitive cardiac care.