Implementation of guidelines improves the standard of care: the Viennese registry on reperfusion strategies in ST-elevation myocardial infarction (Vienna STEMI registry).
BACKGROUND
The purpose of this study was to determine whether implementation of recent guidelines improves in-hospital mortality from acute ST-elevation myocardial infarction (STEMI) in a metropolitan area.


RESULTS
We organized a network that consisted of the Viennese Ambulance Systems, which is responsible for diagnosis and triage of patients with acute STEMI, and 5 high-volume interventional cardiology departments to expand the performance of primary percutaneous catheter intervention (PPCI) and to use the fastest available reperfusion strategy in STEMI of short duration (2 to 3 hours from onset of symptoms), either PPCI or thrombolytic therapy (TT; prehospital or in-hospital), respectively. Implementation of guidelines resulted in increased numbers of patients receiving 1 of the 2 reperfusion strategies (from 66% to 86.6%). Accordingly, the proportion of patients not receiving reperfusion therapy dropped from 34% to 13.4%, respectively. PPCI usage increased from 16% to almost 60%, whereas the use of TT decreased from 50.5% to 26.7% in the participating centers. As a consequence, in-hospital mortality decreased from 16% before establishment of the network to 9.5%, including patients not receiving reperfusion therapy. Whereas PPCI and TT demonstrated comparable in-hospital mortality rates when initiated within 2 to 3 hours from onset of symptoms, PPCI was more effective in acute STEMI of >3 but <12 hours' duration.


CONCLUSIONS
Implementation of recent guidelines for the treatment of acute STEMI by the organization of a cooperating network within a large metropolitan area was associated with a significant improvement in clinical outcomes.
Kalla
Karim
K
Wilhelminenhospital, 3rd Medical Department, Medical University Vienna, Austria.
Christ
Günter
G
Karnik
Ronald
R
Malzer
Reinhard
R
Norman
Georg
G
Prachar
Herbert
H
Schreiber
Wolfgang
W
Unger
Gerhard
G
Glogar
Helmut D
HD
Kaff
Alfred
A
Laggner
Anton N
AN
Maurer
Gerald
G
Mlczoch
Johannes
J
Slany
Joerg
J
Weber
Heinrich S
HS
Huber
Kurt
K
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000592:standards*; D001317:Austria / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000601:surgery / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000592:standards*; D011785:Quality Assurance, Health Care; D012042:Registries; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000453:epidemiology; D013997:Time Factors