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ST-Elevation Acute Myocardial Infarction: we can learn from each other

The results of EuroHeart Survey Acute Coronary Syndrome II have been presented for the first time.

Franz Weidinger

“The first observation we can raise from EuroHeart II is that out of 6356 patients with acute coronary syndromes enrolled in the registry, 3039 (48%) presented with ST elevation, but only 1847 (61%) of them receive primary reperfusion. And the major reasons for excluding patients from primary reperfusion were late arrival (27%), uncertain diagnosis (15%) and, interestingly, early ST elevation resolution (11%)” Dr Behar said.

What kind of reperfusion did Franz W patients receive in Europe? In 59% of cases a mechanical reperfu- sion was achieved either with primary or facilitated PCI, and 41% of cases receive thrombolysis.

“Compared to EuroHeart I, in EuroHeart II primary PCI increased from 37% to 59%, as the use of recommended drugs, particularly station (from54% to 83%), translating in a lower early crude mortality rates at 30 days from 8.4% to 6.8%.” Dr Behar concluded.

THE PRAGUE EXPERIENCE

“In Prague in 1930 we attempted the first cardiac catheterization in patient” Dr Widimsky said.” And since 1995 all STEMI in our center are treated by primary PCI. We have demonstrated in Prague-2 that a properly organized transport does not delay reperfusion, and that a transport strategy improves 30-day mortality. Time is muscle and to minimize delays it is important to avoid clinical discussion, and just have immediate transfer to cath lab without stop in the ER or in the CCU. The cath-lab must be flexible. In our experience with a well organized transport strategy – and with 70% of the cases presenting in urban areas with PCI available – facilitated PCI with thrombolysis before PCI is an excellent concept, but is needed only for a minority of STEMI patient” Dr Widimsky concluded.

PCI IN KRAKOW

“The Krakow experienced in primary PCI has improved in the past 5 year with more than 1500 primary PCI in 2004” Dr Dudek said. “We have an area of more than 3.2 million population referred by local hospital to our center and the distances make difference in transportation time from 60 min to 180 minutes. We apply a protocol including direct transfer to cath-lab for primary PCI, without adjunctive anti clot treatment, in patients with a trans- fer delay < 30 min, Abcximab, admin istered during transportation, in patients with a transfer delay < 90 min, while abcximab+1/2 lytic is given to patients with transfer delay >90 min. With this protocol, despite a delay of mean 150 min, because of transportation MACE rates at 12 months were similar for facilitated PCI and primary PCI. Combined therapy opens infarct related artery and in 86% of cases.” “Community Hospitals, interventional centers and ambulance service should set up networks for STEMI.” Dr Dudek concluded.

LOCAL NETWORK

“STEMI treatment is different in different countries, ESC PCI guidelines will be a further stimulus for an increase in the use of primary PCI.” Dr Weidinger said. “Local network for STEMI management will have different characteristics and problems in different regions and countries. The Euro Heart Survey for Primary PCI can be a tool to verify how we are treating MI patients in respectful of guidelines.” he concluded.

ESC Working group on Interventional Cardiology
and Acute Cardiac Care at EuroPCR.

Souvenirs from Paris

Yesterday morning’s session on acute coronary syndromes presented the experience of several countries to evaluate the application of European PCI guidelines. Professor Antoine Lafont provided three take-home messages. First of all, strategies differ in different populations, but a consensus has emerged: fast opening of the culprit artery, and administration of primary PCI within 90 minutes. On the question of facilitated PCI, no clinical evidence has emerged supporting routine use, but the results of ASSENT-4 and FINESSE may provide a new vision in the future.
The second message concerns distal protection and thrombectomy devices. Based on the results of the EMERALD trial, no current evidence exists supporting the use of protection devices for improving perfusion or infarct size. However, myocardial perfusion is essential to define prognosis, improve understanding of the disease, and strategy definition.
Third message: The EUROHEART survey is a key tool to evaluate the real world in Europe through the internet (ehs@escardio.com). Registries are essential to provide a common database, hence the CARDS initiative.

Fuente: Euro PCR Online 2005

Ultima actualizacion: 31 DE MAYO DE 2005

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