Temporal and spatial distribution of ST-elevation myocardial infarction admissions in a countrywide registry
A Pipilis1, G Andrikopoulos, J Lekakis
1Hygeia Hospital, Athens, Greece. a.pipilis@hygeia.gr
Insights
Most ST-elevation myocardial infarction (STEMI) patients can be treated locally, reducing the need for immediate transfer for primary PCI. This analysis of reperfusion strategies highlights opportunities for improved national STEMI care.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Current ST-elevation myocardial infarction (STEMI) guidelines recommend reperfusion strategies based on time, resources, and patient factors.
- Analyzing the current situation is crucial for implementing effective national reperfusion strategies.
- Understanding patient presentation patterns is key to optimizing STEMI care pathways.
Purpose of the Study:
- To describe the presentation patterns of STEMI patients across a countrywide registry.
- To analyze where and when STEMI patients access healthcare facilities.
- To inform national strategies for improving STEMI reperfusion rates.
Main Methods:
- The Hellenic Infarction Observation Study (HELIOS) enrolled 1096 STEMI patients from 31 diverse hospitals.
- Data collected included patient presentation times and hospital type (invasive vs. non-invasive).
- Proportions of patients fitting various treatment algorithm categories were recorded.
Main Results:
- 28.7% of STEMI patients were admitted to invasive hospitals within 12 hours; 5.9% after 12 hours.
- 34.9% presented to non-invasive hospitals within 3 hours; 19.3% between 3-12 hours; 11% after 12 hours.
- Significant proportions of patients in non-invasive settings were not reperfused (26% and 30% in specific timeframes).
Conclusions:
- Many STEMI patients present to hospitals capable of local treatment within guideline-recommended timeframes.
- A smaller group of late presenters in non-invasive centers may benefit from transfer for primary PCI.
- Data supports tailored national reperfusion strategies, as not all STEMI patients require immediate transfer.
Background:
Current guidelines propose different reperfusion strategies for ST-elevation myocardial infarction (STEMI) depending on the time delay from pain onset, the availability of a catheterization laboratory and the patient's characteristics. In order to implement national strategies to improve reperfusion rates the existing situation must be first analysed. The aim of this report is to provide a description of where and when STEMI patients present in a countrywide registry.
Methods:
The Hellenic Infarction Observation Study (HELIOS) was a countrywide registry that enrolled 1096 patients with STEMI from 31 hospitals with a proportional representation of all types of hospitals from all geographical areas. We recorded the proportion of patients that fits within each category of treatment algorithms.
Results:
The following percentages of the total STEMI population were recorded: a) admitted in invasive hospitals within 12 h 28.7% (with 26% of those not reperfused) and after 12 h 5.9% and b) admitted in non-invasive hospitals within 3 h 34.9% (with 30% of those not reperfused), 3-12 h 19.3% and after 12 h 11%.
Conclusions:
A large proportion of STEMI patients are admitted either in an invasive hospital within 12 h or in a non-invasive one within 3 h from pain onset and therefore can be treated locally according to the guidelines. A relatively small percentage of patients are late presenters in non-invasive centres and are candidates for immediate transfer for primary PCI. These data could be useful in planning reperfusion strategies at countrywide level since not all patients may require immediate transfer for primary PCI.
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