SEVEN-YEAR TRENDS IN THE CROATIAN PRIMARY PERCUTANEOUS CORONARY INTERVENTION NETWORK
Insights
Croatian heart attack treatment improved with percutaneous coronary intervention (PCI) despite sicker patients and new centers. While door-to-balloon times decreased, prehospital delays remain a concern for STEMI outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- The Croatian primary Percutaneous Coronary Intervention (pPCI) Network has treated ST-elevation myocardial infarction (STEMI) patients since 2005.
- Assessing network performance over time is crucial for understanding treatment trends and outcomes.
Purpose of the Study:
- To evaluate trends in STEMI treatment outcomes within the Croatian pPCI Network over three distinct time periods.
- To analyze changes in patient risk profiles, treatment times, and major adverse cardiovascular events (MACE).
Main Methods:
- Retrospective analysis of 5650 STEMI patients treated with pPCI across 11 centers between 2005 and 2011.
- Comparison of patient demographics, clinical characteristics, door-to-balloon times, and MACE rates across three phases: 2005-2007, 2008-2009, and 2010-2011.
- Multivariate log-linear analysis to assess the impact of risk profiles on treatment outcomes.
Main Results:
- The number of STEMI patients treated annually with pPCI significantly increased over the study period.
- Patient risk profiles worsened, indicated by increased age, anterior wall involvement, shock rates, and a higher percentage of transferred patients.
- Door-to-balloon times decreased significantly, but symptom onset-to-door times increased. Final TIMI 3 flow, in-hospital, and six-month mortality rates showed no significant changes.
- Angina pectoris and other MACE rates increased significantly over time, potentially due to changes in pPCI strategy and increased center availability.
Conclusions:
- The Croatian pPCI Network demonstrated sustained high-quality STEMI treatment despite a worsening patient risk profile and network expansion.
- Improvements in door-to-balloon times were achieved, but reducing prehospital delays is essential for further optimization.
- Increased MACE rates may be linked to evolving treatment strategies and greater access to post-STEMI PCI procedures.
Abstract:
The authors investigated trends in the Croatian primary Percutaneous Coronary Intervention (pPCI) Network results among three consecutive time intervals (2005-2007, first phase; 2008-2009, second phase; and 2010-2011, third phase). Data on 5650 patients with acute myocardial infarction with ST-elevation (STEMI) transferred or directly admitted and treated with pPCI in 11 Croatian PCI centers during the study period were collected and analyzed. The number of patients with acute STEMI treated with pPCI per year rose continuously during the study period (581 vs. 1272 vs. 1949 patients/year). The patient risk profile worsened during the study period: age (60 vs. 61 vs. 63 years; p<0.01), anterior myocardial wall involvement (43% vs. 44% vs. 51%; p<0.01), shock rate (7% vs. 9% vs. 11%; p<0.05), and percentage of transferred patients (42% vs. 36% vs. 46%; p<0.01). While the door-to-balloon time shortened (108 vs. 98 vs. 75 min; p<0.01), the symptom onset-to-door time increased (130 vs. 175 vs. 195 min; p<0.01), but without statistically significant influence on the total ischemic time. Multivariate log-linear analysis eliminated influence of a higher risk profile on the results of treatment and yielded no statistically significant changes in final TIMI 3 flow (Thrombolysis In Myocardial Infarction 3), in-hospital mortality, and six-month mortality rate, but revealed a significant increase in the rate of angina pectoris (12 vs. 22 vs. 36%; p<0.01) and other major adverse cardiovascular events (MACE; 6 vs. 23 vs. 14%; p<0.01) during follow up. In conclusion, the Croatian pPCI Network continuously ensures very good results of STEMI treatment in this economically less developed European country despite worsening of the risk profile in treated patients and opening of new, less experienced PCI centers. The higher percentage of MACE over time could be explained by changes in the pPCI strategy introduced over time (the culprit lesion only) and higher availability of PCI centers for additional PCI after acute STEMI. However, there is room for improvement, especially in reducing prehospital delay.
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