Care of patients with ST-elevation myocardial infarction: an international analysis of quality indicators in the acute coronary syndrome STEMI Registry of the EURObservational Research Programme and ACVC and EAPCI Associations of the European Society of Cardiology in 11 462 patients
Peter Ludman, Uwe Zeymer, Nicolas Danchin, Petr Kala, Cécile Laroche, Masoumeh Sadeghi, Roberto Caporale, Sameh Mohamed Shaheen, Jacek Legutko, Zaza Iakobishvili, Khalid F. AlHabib, Zuzana Moťovská, Martin Studenčan, Jorge Mimoso, Dávid Becker, Dimitrios Alexopoulos, Zviad Kereseselidze, Siniša Stojković, Parounak Zelveian, Artan Goda, Erkin М Мirrakhimov, Gani Bajraktari, Hasan Ali Farhan, Pranas Šerpytis, Bent Raungaard, Toomas Marandi, Alice Moore, Martin Quinn, Pasi P. Karjalainen, Gabriel Tatu-Chitoiu, Chris P Gale, Aldo P. Maggioni, Franz Weidinger, ACVC-EAPCI EORP ACS STEMI investigators group of the ESC, A Goda, Naltin Shuka, E Pavli, E Tafaj, Taulant Gishto, Alban Dibra, Arvi Duka, A Gjana, Aleksandra S. Kristo, G Knuti, Aurel Demiraj, E Dado, Endri Hasimi, Leonard Simoni, M Siqeca, Hamayak Sisakian, Hamlet Hayrapetyan, S. A. Markos’yan, L Galustyan, N Arustamyan, H Kzhdryan, Sergey Pepoyan, A Zirkik, Dirk von Lewinski, S Paetzold, I Kienzl, K Mátyás, Thomas Neunteufl, Mariam Nikfardjam, U Neuhold, A Mihalcz, F Glaser, Clemens Steinwender, Christian Reiter, Michael Grund, Dragan Hrnčić, Uta C. Hoppe, Matthias Hammerer, Lynne Hinterbuchner, Christian Hengstenberg, Georg Delle Karth, Iréne Lang, Franz Weidinger, W. Winkler, Matthias Hasun, Johannes Kästner, C. Havel, Michael Derntl, G Oberegger, Johannes Hajos, Christopher Adlbrecht, T. Publig, M-C Leitgeb, R Wilfing, Peter Jirak, Carolyn Y. Ho, L Puskas, Lore Schrutka, Jindřich Špinar, Jiří Pařenica, Ota Hlinomaz, V Fendrychova, Jiří Seménka, J Sikora, Jan Sitar, Ladislav Groch
Abstract
AIMS: To use quality indicators to study the management of ST-segment elevation myocardial infarction (STEMI) in different regions. METHODS AND RESULTS: Prospective cohort study of STEMI within 24 h of symptom onset (11 462 patients, 196 centres, 26 European Society of Cardiology members, and 3 affiliated countries). The median delay between arrival at a percutaneous cardiovascular intervention (PCI) centre and primary PCI was 40 min (interquartile range 20-74) with 65.8% receiving PCI within guideline recommendation of 60 min. A third of patients (33.2%) required transfer from their initial hospital to one that could perform emergency PCI for whom only 27.2% were treated within the quality indicator recommendation of 120 min. Radial access was used in 56.6% of all primary PCI, but with large geographic variation, from 76.4 to 9.1%. Statins were prescribed at discharge to 98.7% of patients, with little geographic variation. Of patients with a history of heart failure or a documented left ventricular ejection fraction ≤40%, 84.0% were discharged on an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and 88.7% were discharged on beta-blockers. CONCLUSION: Care for STEMI shows wide geographic variation in the receipt of timely primary PCI, and is in contrast with the more uniform delivery of guideline-recommended pharmacotherapies at time of hospital discharge.