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[STEMI network Essen-in-hospital results].

Jochen Buchholz1, Christoph K Naber, Thomas Budde

  • 1Klinik für Innere Medizin I und Kardiologie, Alfried Krupp Krankenhaus, Essen. jochen.buchholz@krupp-krankenhaus.de

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Implementing guideline-based therapy for ST-elevation myocardial infarction (STEMI) in urban areas significantly lowers in-hospital mortality and improves patient adherence to recommended medications and rehabilitation.

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Area of Science:

  • Cardiology
  • Public Health
  • Health Services Research

Background:

  • The "Herzinfarktverbund Essen" network was established in 2004 to integrate guideline-recommended therapy for ST-elevation myocardial infarction (STEMI) into routine clinical practice.
  • The network focused on primary percutaneous coronary intervention (PCI) as the primary reperfusion method, early medication prescription, and optimized patient care pathways.

Purpose of the Study:

  • To evaluate the effectiveness of a structured, urban-wide network for STEMI care in improving patient outcomes.
  • To assess the impact of guideline-conformal STEMI management on in-hospital mortality, medication adherence, and rehabilitation referral rates.

Main Methods:

  • The study analyzed data from the first year of the "Herzinfarktverbund Essen" network, involving 489 patients treated in five high-volume PCI centers.
  • Primary PCI was performed in 90.8% of STEMI cases.

Main Results:

  • In-hospital mortality was 7.6%, which was lower compared to historical STEMI registries with less frequent PCI.
  • Left ventricular ejection fraction (EF) was the strongest predictor of mortality; EF ≤30% correlated with a 27-fold increased risk.
  • Guideline-recommended medications were prescribed to 75% of patients, with 71% receiving a five-drug regimen including ACE inhibitors.
  • 72% of patients were referred to rehabilitation therapy.

Conclusions:

  • The "Herzinfarktverbund Essen" network successfully demonstrated that implementing guideline-conformal STEMI therapy in an urban setting can reduce in-hospital mortality.
  • The network also led to increased prescription rates of recommended medications and improved patient adherence to outpatient therapies.