title: Implementation of guidelines improves the standard of care: the Viennese registry on reperfusion strategies in ST-elevation myocardial infarction (Vienna STEMI registry).
abstract: 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.
authors.affiliation: Wilhelminenhospital, 3rd Medical Department, Medical University Vienna, Austria.
authors.forename: Karim
authors.initials: K
authors.lastname: Kalla
authors.forename: Günter
authors.initials: G
authors.lastname: Christ
authors.forename: Ronald
authors.initials: R
authors.lastname: Karnik
authors.forename: Reinhard
authors.initials: R
authors.lastname: Malzer
authors.forename: Georg
authors.initials: G
authors.lastname: Norman
authors.forename: Herbert
authors.initials: H
authors.lastname: Prachar
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Schreiber
authors.forename: Gerhard
authors.initials: G
authors.lastname: Unger
authors.forename: Helmut D
authors.initials: HD
authors.lastname: Glogar
authors.forename: Alfred
authors.initials: A
authors.lastname: Kaff
authors.forename: Anton N
authors.initials: AN
authors.lastname: Laggner
authors.forename: Gerald
authors.initials: G
authors.lastname: Maurer
authors.forename: Johannes
authors.initials: J
authors.lastname: Mlczoch
authors.forename: Joerg
authors.initials: J
authors.lastname: Slany
authors.forename: Heinrich S
authors.initials: HS
authors.lastname: Weber
authors.forename: Kurt
authors.initials: K
authors.lastname: Huber
mesh_terms: 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