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Updated: Aug 13, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
[Interventional therapy of acute ST-elevation myocardial infarction in a regional network]
H Schneider1, F Weber, L Paranskaja
1Drip&Ship-Netzwerk: Klinik und Poliklinik fur Innere Medizin, Universität Rostock, Abt. Kardiologie, Postfach 100-888, 18055 Rostock.
Insights
Establishing a regional ST-elevation myocardial infarction (STEMI) network improves timely percutaneous coronary intervention (PCI) in rural areas. This network ensures guideline-adherent treatment, reducing reliance on thrombolytic therapy for STEMI patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Healthcare Network Management
Background:
- Acute ST-elevation myocardial infarction (STEMI) management requires rapid reperfusion of the infarct-related artery (IRA).
- Primary percutaneous coronary intervention (PCI) is superior to thrombolytic therapy but often unavailable in rural settings.
- A regional STEMI network was established in rural Germany, linking community hospitals without PCI facilities to an interventional center.
Purpose of the Study:
- To evaluate the effectiveness of a regional STEMI network in providing timely PCI.
- To compare outcomes for STEMI patients transferred from community hospitals versus those admitted directly to an interventional center.
Main Methods:
- Analysis of 322 STEMI patients treated with PCI within the network.
- Comparison between 160 transferred patients (TG) and 162 directly admitted patients (CG).
- Assessment of symptom onset to first medical contact, transportation times, and procedural success.
Main Results:
- No significant difference in symptom onset to first medical contact time between groups.
- Successful PCI of the IRA achieved in over 94% of patients in both groups.
- Comparable infarct size, mortality rates (30 days, 6 months, 12 months), NYHA class, and left ventricular ejection fraction between TG and CG.
Conclusions:
- A regional STEMI network effectively ensures timely PCI for patients in rural areas.
- This organizational model facilitates guideline-adherent STEMI management.
- The network relegates thrombolytic treatment to bail-out scenarios, optimizing patient care.
Background And Objectives:
Management of acute ST-elevation myocardial infarction (STEMI) demands rapid and complete reflow to the infarct related artery (IRA). Primary PCI (percutaneous coronary intervention) performed by experienced operators is superior to thrombolytic thrombolytic therapy and reduces mortality, occurrence of non-fatal reinfarction and stroke, but is not available in rural Germany. We established a regional infarction-network using established therapeutic guidelines comprising of 1 interventional center and 7 referring community hospitals without PCI facilities.
Patients And Methods:
We analyzed 322 patients with STEMI treated by PCI within the network; 160 patients were transferred from a community hospital without PCI facilities (transfer group (TG): 63.4 yrs., 71.8% men) and 162 patients were admitted directly to the interventional center (center group (CG): 61.7 yrs., 73.8% men). The interval from onset of symptoms to first medical contact was 205 minutes in TG, and 195 minutes in CG (n.s.); 7.8% of the CG and 7.2% of the TG patients were in cardiogenic shock; 95% of patients completed 12- months of follow-up.
Results:
In the TG, median transportation time to PCI was 54 minutes. PCI of the infarct-related artery (IRA) was performed in 95.1% of TG patients and in 94.1% of CG patients. In addition, 96% of all patients received a GP IIb/IIIa receptor inhibitor. In case of pre-interventional application of GP IIb/IIIa receptor inhibitor 22.3% of patients revealed TIMI-3 flow of the IRA before PCI. After PCI, normalized flow to the IRAwas documented in 87.5% of CG versus 86.3% of TG. There were no differences between groups with respect to infarct size (TG vs. CG: CK 2482 vs. 2481 U/I; CKMB 302 vs. 264 U/I), mortality (30 days: 5.3 vs. 5.2%, 6 months: 7.3 vs. 7.1%, 12 months: 7.9 vs. 7.8%); NYHA (1.41 vs. 1.43) and left ventricular ejection fraction (0.41 vs. 0.43).
Conclusions:
The organization of a regional STEMI-network with logistic alliance of community hospitals and one experienced interventional center ensures timely PCI treatment of patients with STEMI according to present guidelines even in rural areas, and relegates thrombolytic treatment to bail-out scenarios only.
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