Background: Myocardial infarction (MI) remains a leading cause of morbidity and mortality worldwide. Early recognition of ST-elevation MI (STEMI) and prompt activation of pre-hospital percutaneous coronary intervention (PCI) are critical for improving patient outcomes. The World Health Organization defines MI based on the presence of chest discomfort, elevated troponin levels, and ECG changes. Aim: This study aimed to assess the impact of early STEMI recognition and pre-hospital PCI activation on mortality rates in Madinah, Saudi Arabia. Methods: A retrospective cohort study was conducted involving patients diagnosed with STEMI by the Saudi Red Crescent Authority (SRCA) and transported to the Madinah Cardiac Center between January 2022 and December 2023. Data were collected from hospital records, electronic patient care reports, and patient contact. Key variables included demographic data, medical history, pre-hospital interventions, time intervals (call-to-balloon [C2B], first medical contact-to-balloon [FMC2B], the time from when treatment by a healthcare provider begins to balloon time, and door-to-balloon [D2B]), and patient outcomes. Statistical analysis was performed using JMP statistical software version 17.2.0. Results: A total of 76 patients were analyzed, predominantly male (88%), with a mean age of 57 years. Early STEMI recognition and pre-hospital PCI activation resulted in a mean C2B time of 90 minutes, FMC2B time of 68 minutes, and D2B time of 33 minutes. Most patients (93%) underwent PCI upon arrival. Outcomes showed that 76% of patients recovered without complications, 16% recovered with complications, 4% worsened, and 4% died. Conclusions: Early recognition of STEMI and pre-hospital PCI activation significantly improved patient outcomes, in adherence to international time benchmarks. These findings highlight the need for continued efforts to optimize emergency medical services (EMS) protocols and public awareness to further reduce mortality rates.

Keywords: STEMI, MI, early recognition, outcome, C2B, FMC2B, D2B pre-hospital PCI activation, mortality, EMS, time-to-treatment.