Managing Acute Myocardial Infarction in Remote Oman: Real-world data from Al Wusta Governorate

Objectives: Acute ST-segment elevation myocardial infarction (STEMI) is a time-sensitive cardiac emergency requiring prompt reperfusion therapy. Management and outcomes in remote areas are underexplored. This study explored the STEMI reperfusion network in Al Wusta governorate in Oman and evaluated the effectiveness of pharmacological thrombolysis in general practitioner (GP)-led, resource-limited hospitals. Methods: This retrospective study reviewed administrative health registries and medical records of patients presenting with STEMI to hospitals in the Al Wusta governorate between June 2017 and December 2024. Response to thrombolysis was defined as 50% resolution of ST-segment on electrocardiogram. Outcomes post-thrombolysis were prespecified. Multivariate logistic regression was used to identify predictors of thrombolysis failure. Results: A total of 139 patients were included and received pharmacological thrombolysis, of whom 136 (97.8%) were male and the mean age was 47.8 ± 9.8 years. Thrombolysis failed in 13 patients (9.4%); all 3 deaths (2.2%) occurred in this subgroup, representing a mortality rate of over 20% among those with failed thrombolysis. Alcohol consumption and anterolateral myocardial infarction were strongly associated with failed thrombolysis, with odds ratios of 4,417.7 (95% confidence interval [CI]: 22.4-868,125.8) and 48.9 (95% CI: 2.0-1,156.8), respectively. The reperfusion network functioned effectively despite the absence of percutaneous coronary intervention centres and formal emergency medical services. Conclusion: While high rates of successful pharmacological reperfusion were achieved in GP-led hospitals, failed thrombolysis remains a significant concern. Targeted interventions at both patient and health system levels are necessary to improve outcomes. This study offers valuable insights for optimising STEMI care and guiding policy development in underserved regions.