[Interventional therapy of acute ST-elevation myocardial infarction in a regional network].
OBJECTIVE
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.


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.
Schneider
H
H
Drip&Ship-Netzwerk: Klinik und Poliklinik fur Innere Medizin, Universität Rostock, Abt. Kardiologie, Postfach 100-888, 18055 Rostock.
Weber
F
F
Paranskaja
L
L
Holzhausen
C
C
Petzsch
M
M
Nienaber
C A
CA
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D019058:Community Networks; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D017052:Hospital Mortality; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D012017:Referral and Consultation; D055502:Secondary Prevention; D020521:Stroke / Q000517:prevention & control; D015996:Survival Rate; D015912:Thrombolytic Therapy