Reperfusion Therapies and Outcomes for STEMI

Dec 02, 2021
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Authors:
Zeymer U, Ludman P, Danchin N, et al., on behalf of the ACVC EAPCI EORPACS STEMI Investigators Group of the ESC.
Citation:
Reperfusion Therapies and In-Hospital Outcomes for ST-Elevation Myocardial Infarction in Europe: The ACVC-EAPCI EORP STEMI Registry of the European Society of Cardiology. Eur Heart J 2021;42:4526-4549.
Summary By:
Debabrata Mukherjee, MD, FACC

Quick Takes

  • Primary PCI was the preferred reperfusion therapy in patients with STEMI in Europe and participating Middle East countries.
  • However, approximately 10% of patients still did not receive reperfusion therapy, with late presentation as the most often reported reason.
  • Public campaigns are still warranted to help minimize patient-related prehospital delays, to reduce the rate of patients presenting too late to benefit from early reperfusion therapy.

Study Questions:

What is the contemporary use of reperfusion therapy in the European Society of Cardiology (ESC) member and affiliated countries, and adherence to ESC clinical practice guidelines in patients with ST-segment elevation myocardial infarction (STEMI)?

Methods:

The investigators analyzed a prospective cohort (EURObservational Research Programme STEMI Registry) of hospitalized STEMI patients with symptom onset <24 hours in 196 centers across 29 countries. Descriptive statistics are used to summarize frequency tabulations (n, %) and distributions (mean, standard deviation).

Results:

A total of 11,462 patients were enrolled, for whom primary percutaneous coronary intervention (PCI) (total cohort frequency, 72.2%; country frequency range, 0-100%), fibrinolysis (18.8%; 0-100%), and no reperfusion therapy (9.0%; 0-75%) were performed. Corresponding in-hospital mortality rates from any cause were 3.1%, 4.4%, and 14.1% and overall mortality was 4.4% (country range, 2.5-5.9%). Achievement of quality indicators for reperfusion was reported for 92.7% (region range, 84.8-97.5%) for the performance of reperfusion therapy of all patients with STEMI <12 hours and 54.4% (region range, 37.1-70.1%) for timely reperfusion.

Conclusions:

The authors concluded that the use of reperfusion therapy for STEMI in the ESC member and affiliated countries was high, with geographic variation in the use of primary PCI.

Perspective:

This registry reports that primary PCI was the preferred reperfusion therapy in patients with STEMI in Europe and participating Middle East countries. However, approximately 10% of patients still did not receive reperfusion therapy, with late presentation as the most often reported reason. Based on these data, public campaigns are still warranted to help minimize patient-related prehospital delays, to reduce the rate of patients presenting too late to benefit from early reperfusion therapy. Furthermore, cardiogenic shock was still associated with a high mortality rate of 35% and major improvements in total mortality rates can only be achieved if mortality due to cardiogenic shock can be lowered. Finally, further improvements in STEMI care will require strong commitment from the medical community as well as support from hospitals and funding agencies.

Clinical Topics: Acute Coronary Syndromes, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Prevention, Stable Ischemic Heart Disease, Vascular Medicine, Acute Heart Failure, Interventions and ACS, Interventions and Vascular Medicine, Chronic Angina

Keywords: Acute Coronary Syndrome, Biometry, Emergency Medical Services, Fibrinolysis, Hospital Mortality, Myocardial Infarction, Percutaneous Coronary Intervention, Quality Indicators, Health Care, Reperfusion, Secondary Prevention, Shock, Cardiogenic, ST Elevation Myocardial Infarction


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