How to set up an effective national primary angioplasty network: lessons learned from five European countries.
OBJECTIVE
Percutaneous coronary interventions (PCI) are used to treat acute and chronic forms of coronary artery disease. While in chronic forms the main goal of PCI is to improve the quality of life, in acute coronary syndromes (ACS) timely PCI is a life-saving procedure - especially in the setting of ST-elevation myocardial infarction (STEMI). The aim of this study was to describe the experience of countries with successful nationwide implementation of PCI in STEMI, and to provide general recommendations for other countries.


RESULTS
The European Association of Percutaneous Cardiovascular Interventions (EAPCI) recenty launched the Stent For Life Initiative (SFLI). The initial phase of this pan-European project was focused on the positive experience of five countries to provide the best practice examples. The Netherlands, the Czech Republic, Sweden, Denmark and Austria were visited and the logistics of ACS treatment was studied. Public campaigns improved patient access to acute PCI. Regional networks involving emergency medical services (EMS), non-PCI hospitals and PCI centres are useful in providing access to acute PCI for most patients. Direct transfer from the first medical contact site to the cathlab is essential to minimise the time delays. Cathlab staff work is organised to provide acute PCI services 24 hours a day / seven days a week (24/7). Even in those regions where thrombolysis is still used due to long transfer distances to PCI, patients should still be transferred to a PCI centre (after thrombolysis). The highest risk non-ST elevation acute myocardial infarction patients should undergo emergency coronary angiography within two hours of hospital admission, i.e. similar to STEMI patients.


CONCLUSIONS
Three realistic goals for other countries were defined based on these experiences: 1) primary PCI should be used for >70% of all STEMI patients, 2) primary PCI rates should reach >600 per million inhabitants per year and 3) existing PCI centres should treat all their STEMI patients by primary PCI, i.e. should offer a 24/7 service.
Knot
Jiri
J
Cardiocenter, Department of Cardiology, 3rd Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic. knot@fnkv.cz
Widimsky
Petr
P
Wijns
William
W
Stenestrand
Ulf
U
Kristensen
Steen Dalby
SD
Van' T Hof
Arnoud
A
Weidinger
Franz
F
Janzon
Magnus
M
Nörgaard
Bjarne Linde
BL
Soerensen
Jacob Thorsted
JT
van de Wetering
Henri
H
Thygesen
Kristian
K
Bergsten
Per-Adolf
PA
Digerfeldt
Christofer
C
Potgieter
Adriaan
A
Tomer
Nadav
N
Fajadet
Jean
J
D054058:Acute Coronary Syndrome / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D039602:After-Hours Care / Q000458:organization & administration; D015906:Angioplasty, Balloon, Coronary; D019985:Benchmarking; D002908:Chronic Disease; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D004632:Emergency Medical Services / Q000458:organization & administration; D005060:Europe; D006297:Health Services Accessibility / Q000458:organization & administration; D006761:Hospitals; D006801:Humans; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D009313:National Health Programs / Q000458:organization & administration*; D009937:Organizational Objectives; D010360:Patient Transfer / Q000458:organization & administration; D017410:Practice Guidelines as Topic; D016730:Program Development; D012040:Regional Health Planning / Q000458:organization & administration*; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome