Clinical InvestigationAcute Ischemic Heart DiseaseA prospective regional registry of ST-elevation myocardial infarction in Central Romania: Impact of the Stent for Life Initiative recommendations on patient outcomes
Section snippets
Background
European Society of Cardiology (ESC) guidelines recommend primary percutaneous coronary intervention (pPCI), if available, as the first-option therapy for patients with ST-elevation myocardial infarction (STEMI) within 90 to 120 minutes of the first medical contact, especially for those presenting earlier than 12 hours after the onset of symptoms.1 When PCI is not available within 90 to 120 minutes of the first medical contact, thrombolysis is the alternative strategy for reperfusion and should
Logistic network
An STEMI network was initiated in 2004 in a central Romanian territory of 1,133,307 people, encompassing 1 pPCI academic center with an emergency hospital and 13 territorial urban hospitals without catheterization facilities (11 municipal hospitals and 2 county hospitals) located in the surrounding area, distributed in 3 zones according to the distance between them and the pPCI center (zone 1, maximum 60 km; zone 2, 60-120 km; zone 3, 120-200 km) (Figure 1).
To facilitate the early transport of
Results
Between January 1, 2004, and December 31, 2011, 5,899 patients with STEMI were enrolled in the registry. Baseline characteristics of the study population in relation to the treatment strategy are listed in Table I.
Multivariate logistic regression analysis for predictors of not receiving reperfusion therapy in a population with STEMI showed that besides presentation outside the recommended 12-hour time frame, presentation to a territorial hospital instead of a pPCI center (odds radio 3.9, 95% CI
Discussion
Many prior studies (ASSENT, DANAMI, TRANSFER-AMI) have proven that reperfusion therapy, when initiated within 12 hours after the onset of symptoms, is the treatment of choice in patients with STEMI and should be started as soon as possible.4., 5., 6., 7. However, the effectiveness of these therapies depends on the access to well-organized emergency care.1., 2. Many registries have demonstrated that, in the real world, a significant number of patients do not benefit from reperfusion therapy
Conclusions
This study shows that a reduction of STEMI-related mortality by implementing pPCI in a territory of 1 million people was possible even in a country with very low health care expenditures.
The intervention of the appropriate logistic measures in the network had a significant impact and led to a more substantial increase in the total number of patients treated for STEMI.
The major progress of pPCI rates in our experience was recorded after 5 years of intervention in the community, when the most
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2023, The Lancet Regional Health - EuropeImplementation of Regional ST-Segment Elevation Myocardial Infarction Systems of Care: Successes and Challenges
2016, Interventional Cardiology ClinicsCitation Excerpt :Furthermore, the expansion of STEMI networks continues internationally. Implementation of STEMI systems in several Western countries has been associated with reduced reperfusion times in Canada,3,30–32 Australia,33 Austria,34 France,35 and Italy,36 with momentum for regionalization in such countries as Romania, China, South Africa, and Mexico.37,38 Efforts in South America and Asia, with telemedicine as part of the Lumen Foundation (http://lumenglobal.org/), have also made important progress with a focus on low- and middle-income countries.39
Regional systems of care for ST-elevation myocardial infarction: Do they save lives?
2013, American Heart JournalSystematic investment in the delivery of guideline-coherent therapy reduces mortality and overall costs in patients with ST-elevation myocardial infarction: Results from the Stent for Life economic model for Romania, Portugal, Basque Country and Kemerovo region
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