[STEMI network Essen-in-hospital results].
OBJECTIVE
The myocardial infarction network "Herzinfarktverbund Essen", existing since 2004, was designed to introduce guideline therapy of ST elevation myocardial infarction (STEMI) into everyday clinical practice using primary percutaneous coronary intervention (PCI) as the preferred reperfusion strategy, early prescribing recommended medication and optimizing patient's pathway from the first symptom to rehabilitation in a city of 580,000 inhabitants.


METHODS
In the 1st year, 489 patients were treated in five high-volume PCI centers. 444 primary PCIs were performed (90.8%).


RESULTS
In-hospital mortality was 7.6% and thus lower than in other, historical STEMI registers with similar baseline characteristics but lower PCI rate. The best risk predictor was left ventricular function. Patients with an ejection fraction (EF) <or= 30% had a 27 times higher mortality risk than those with normal EF. Guideline-recommended medication was prescribed in 75% of patients (acetylsalicylic acid [ASS], clopidogrel, beta-blockers, and statins) and in 71%, respectively, with additional ACE inhibitor (five drugs). 72% of these patients were referred to rehabilitation therapy.


CONCLUSIONS
The "Herzinfarktverbund Essen" demonstrates, that implementing guideline-conformal therapy into an urban area may result in a lower in-hospital mortality, a higher rate of patients prescribed recommended medication and a stronger patient adherence to ambulant therapy.
Buchholz
Jochen
J
Klinik für Innere Medizin I und Kardiologie, Alfried Krupp Krankenhaus, Essen. jochen.buchholz@krupp-krankenhaus.de
Naber
Christoph K
CK
Budde
Thomas
T
Koslowski
Bernd
B
Hailer
Birgit
B
Jacksch
Rainer
R
Sabin
Georg
G
Haude
Michael
M
Erbel
Raimund
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D015906:Angioplasty, Balloon, Coronary; D002303:Cardiac Output, Low / Q000401:mortality; D003131:Combined Modality Therapy; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D005858:Germany; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D010349:Patient Compliance; D017410:Practice Guidelines as Topic; D012042:Registries; D015996:Survival Rate