Primary angioplasty for any patient with ST-elevation myocardial infarction? Guideline-adherent feasibility and impact on mortality in a rural infarction network.
OBJECTIVE
The aim of this study was to assess the guideline-adherent feasibility of area-wide primary angioplasty in rural German surroundings and its impact on reperfusion and outcome in patients with acute ST-elevation myocardial infarction (STEMI).


RESULTS
All consecutive patients with acute STEMI (n = 347) admitted to any of the hospitals (5 non invasive and 1 invasive with established 24 h/7 days primary angioplasty service) in a 350.000 inhabitant rural area during the year 2002 (n = 184) and 2005 (n = 163) were included in this registry. In 2002, emergency medical services transferred acute STEMI patients to the nearest emergency room, where reperfusion therapy (fibrinolysis or primary angioplasty) was organised. In 2005, all patients were transferred directly to the cathlab bypassing any emergency room when possible. Primary angioplasty increased from 53 to 89% (p < 0.01), fibrinolysis decreased from 27 to 2% (p < 0.01) and the no revascularisation rate from 21 to 9% (p < 0.01). Onset of pain to balloon time in primary angioplasty was reduced from median 339 to 191 min (p < 0.01), median first medical contact to balloon time in 2005 was 101 min. Overall, 6-month mortality decreased from 19 to 10% (p = 0.03).


CONCLUSIONS
After transition to a uniform primary angioplasty concept, an increase in overall reperfusion rates and a decrease in time delays could be observed in a rural German infarction network.
Birkemeyer
Ralf
R
Department of Cardiology, Schwarzwald-Baar-Klinikum, Villingen-Schwenningen, Vöhrenbacherstrasse 23, 78050 Villingen-Schwenningen, Germany. ralf.birkemeyer@sbk-vs.de
Rillig
Andreas
A
Koch
Annette
A
Miljak
Tomislav
T
Kunze
Markus
M
Meyerfeldt
Udo
U
Steffen
Wolfgang
W
Soballa
Martin
M
Ranke
Carsten
C
Prassler
Roland
R
Benzing
Albert
A
Jung
Werner
W
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012042:Registries; D012189:Retrospective Studies; D019035:Rural Health Services / Q000592:standards*; D013997:Time Factors