1.Identification of the site:

• •Name of the Hospital/ Center : *
• •Address of the Hospital/ Center : *
• •Type of Hospital/ Center : *
  GovernmentalSemi GovernmentalPresidentialMilitaryPrivate Other: Please specify
• •Licensed Hospital/ Center: *
  YesNo

CONTACT PHYSICIAN

• Name *
• Mobile *
• Email *
• Nationality *AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiComorosCongo (Brazzaville)CongoCosta RicaCote d\’IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepaNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamYemenZambiaZimbabwe

 

2.ICU facility:

• ICU facility : *
  YesNo
• •Number of beds in the ICU(s): *
• •Number of thrombolysis management per yer *
• •Number of STEMI patients per year: *
• •How do you manage STEMI patients : *
  -Transfer to another hospital-Manage inside the same hospital

Name of the hospital transferred to: *

Way of transfer : *

National ambulanceTaxiPrivate transportation

 

3.Cath lab Facility:

• Cath lab Facility: *
  YesNo
• Type of Cathlab: *
  EPPeripheralNeuroHybridPediatricGeneralNot
• Cath lab working (24/7) *
  YesNo
• Number of cath labs: *
• Number of beds in the cathlab recovery area? *
• Number of beds in the CCU(s): *
• Total Number of clinical cardiologists: *
• Number of National clinical cardiologist: *
• Number of Foreign clinical cardiologist : *
• Total Number of interventional cardiologists: *
• Number of National interventional cardiologist: *
• Number of Foreign interventional cardiologist: *
• Number of Fellows: *
• Number of Nurses: *
• Number of Technical team: *

Coronary interventional activity Per Year:

• Number of coronary angiographies (Diagnostic): *
• Number of coronary interventions (Therapeutic only): *
• Number of Primary PCI: *
• Number of Pharmaco-invasive strategy: *
• Number of TAVI: *
• Number of LAA Occluder: *
• Number of Mitral Clip: *
• Number of ASD: *
• Number of VSD: *
• Others ( please specify ) :

NUMBER OF STENTS USED

• # BMS *
• # DES *
• # BRS (Bioresorbable) *

 

Verification

• Please enter any two digitsExample: 12
• This box is for spam protection – please leave it blank