Access to Catheterization Facilities in Patients Admitted With ST -Elevation Myocardial Infarction: A Pilot Study

Abstract

BACKGROUND: Thrombolytic therapy and percutaneous coronary intervention (PCI) are effective means to achieve reperfusion in ST-elevation myocardial infarction (STEMI), but current trends favour primary PCI. However, there seems to be considerable international and national differences in the management of patients with STEMI. Pertinent epidemiological data for Greece are lacking. Thus, the aim of this pilot study was to investigate the current implementation of reperfusion strategies in North-Western (NW) Greece.

PATIENTS AND METHODS: The region of NW Greece is populated by 600,000 inhabitants, and is served by 6 district hospitals, and 1 tertiary university hospital, the only one offering PCI, but not on a 24-hour basis. Thus, the most prevalent reperfusion strategy in our region is thrombolytic therapy. The present study was a prospective population-based survey conducted over a 5-month period. Sources of data included cardiology departments, coronary care units, and intensive care departments located in the area.

RESULTS: The total study population consisted of 170 consecutive patients (135 men) with a mean age of 67 years, divided into three groups according to time between symptom onset and presentation: 99 patients (58.2%) presented within 3 hours (group I), 23 (13.5%) between 3-12 hours (Group II), and 48 (28.2%) after 12 hours (Group III).

In group I, thrombolysis was performed in 78 (78.7%), primary PCI in 8 (8%) and rescue PCI in 6 (6%); 93 patients (94%) were subjected to elective coronary angiography and subsequently 38 (40.8%) had elective PCI, 4 (4.3%) coronary artery bypass grafting (CABG), and 51 (54.8%) were managed medically. In group II, thrombolysis was given in 17 (73.9%), and rescue PCI in 2 (8.6%) patients; all patients (100%) were subjected to elective coronary angiography and subsequently 10 (43.4%) to elective PCI, and 1 (4.3%) to CABG. In group III, thrombolysis was performed in 4 (8.3%), and rescue PCI in 1 (2.1%) patient; 42 (87.5%) patients were subjected to elective coronary angiography and subsequently 11 (22.9%) had elective PCI, and 8 (16.6%) CABG.

CONCLUSION: A large proportion of patients with STEMI arrive late, but reperfusion therapy is sufficiently implemented in NW Greece. The goal of 75% is certainly attainable. Organizing networks of reperfusion at regional level can help to improve the rate of reperfusion therapy. Finally, the option of next-day PCI after successful thrombolysis is gaining wider acceptance.