Optimal reperfusion in ST-elevation myocardial infarction
Primary PCI is the best reperfusion therapy for patients presenting with acute ST-elevation myocardial infarction. CJ Terkelsen and co-workers used the Western Denmark Heart Registry to describe the implementation of primary PCI in Denmark. Their study (including almost 10,000 patients) showed that a strategy with early diagnosis based on ECG recording in the ambulance and directing the patients straight to the catherization laboratory in the Primary PCI Centre, was associated with a lower mortality.
Direct access to PPCI is unfortunately still not possible in many European countries. A survey from 2007/8 showed that only 40% of European patients with ST-elevation myocardial infarction are treated with primary PCI.
The Stent for Life Initiative launched by the ESC, the EAPCI and EuroPCR is aiming to support the implementation of primary PCI in the ESC countries. Selected target countries are Bulgaria, Egypt, France, Greece, Italy, Portugal, Romania, Serbia, Spain and Turkey.
The barriers for implementation are a complex mix of medical, organizational, patient-related, regulatory and economic factors and differ from country to country. Therefore the action plan for implementation is tailored to the specific needs of each country and managed at country level by the country SFL Initiative supported by national cardiology societies. Preliminary data from several countries show an increase in the numbers of primary PCIs performed after the SFL action plan was launched. More detailed information about changes in availability of primary PCI in Europe will be available next year where the result of the ongoing 2011 survey will be presented.
The activities at the national level are undertaken in close collaboration with the Emergency Medical Service and transportation protocol and campaigns are worked out to decrease treatment delay. System delay can be decreased by an effective pre-hospital diagnosis and triage.
Reduction of patient delay in contacting services is another main target. An important strategy for the Stent for Life Initiative is therefore to launch public awareness campaigns to educate the population about ACS symptoms in order to encourage patients to call the Emergency Medical Services directly by telephone in the event of an acute onset of chest pain.