Local hospital networks for STEMI treatment for a population of half a million inhabitants increase the use of invasive treatment of acute coronary syndromes to the European recommended level. The Małopolska Registry of Acute Coronary Syndromes 2005-2006.
BACKGROUND
According to the European Society of Cardiology (ESC) consensus, over 75% of patients with ST-elevation myocardial infarction (STEMI) should receive reperfusion therapy. An early invasive strategy is also advocated for high-risk non-ST elevation acute coronary syndromes (NSTE ACS). Until 2005, a single high-volume percutaneous coronary intervention (PCI) centre provided 24-hour service for the population of 3.2 million inhabitants in the Krakow Hospital Network Region. In August 2005 and December 2005 two additional round-the-clock duty PCI centres were launched in remote municipal hospitals (Tarnow and Nowy Sacz).


METHODS
29 non-PCI centres participated in the Registry of ACS in February-March 2005 (Period 1) and in December 2005-January 2006 (Period 2), so while Period 2 was conducted, three PCI centres provided 24-hour service for the Małopolska Region.


RESULTS
A total of 1404 patients with ACS were enrolled - 695 during Period 1 and 709 in Period 2. In comparison to Period 1, a non-significant trend towards more frequent mechanical reperfusion of STEMI patients with chest pain onset <12 hours was observed in Period 2 (54 vs. 60%; p=NS). A steep and significant rise was observed particularly among STEMI patients treated in non-PCI centres outside of the Krakow City Network (51 vs. 78%; p=0.001). In the newly established Tarnow and Nowy Sacz (eastern Małopolska) PCI networks the reperfusion rates for STEMI patients with chest pain <12 hours were 78% and 88%, respectively, in comparison to 55% in western Małopolska (p=0.001). The transfer rate for invasive treatment of NSTE ACS has increased from 13.8% in Period 1 to 19% in Period 2 (p=0.031) in the entire region. The in-hospital mortality for patients receiving conservative treatment in community hospitals has decreased among NSTE ACS patients (6.8 vs. 3.9%; p=0.045) and remained unchanged in STEMI (21.3 vs. 19%; p=NS).


CONCLUSIONS
Opening of new PCI centres, based on population magnitude and structure, improves local adherence to the guideline-recommended invasive approach in high-risk ACS patients. The Małopolska Programme model showed that one high-volume 24-hour duty PCI centre with a network of cooperating non-PCI centres for a population of 0.5 million might be sufficient to provide invasive treatment according to the ESC guidelines for eligible patients.
2nd Department of Cardiology, Institute of Cardiology, Collegium Medicum, ul. Kopernika 17, 31-501 Kraków, Poland. mcdudek@cyf-kr.edu.pl
Dariusz
D
Dudek
Zbigniew
Z
Siudak
Artur
A
Dziewierz
Tomasz
T
Rakowski
Waldemar
W
Mielecki
Michał
M
Brzeziński
Wojciech
W
Zasada
Stanisław
S
Bartuś
Bogdan
B
Januś
Jacek S
JS
Dubiel
D054058:Acute Coronary Syndrome / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence; D017052:Hospital Mortality; D006773:Hospitals, Municipal / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D011044:Poland; D012042:Registries