English summary: INCIDENCE AND TREATMENT OF ST-ELEVATION MYOCARDIAL INFARCTION IN FOUR HOSPITAL DISTRICTS: STEMI-2005 STUDY

Background

According to international guidelines, primary percutaneous coronary intervention is the preferred reperfusion strategy in acute ST-elevation myocardial infarction. Alternatively, thrombolytic therapy may be considered in patients with less than three hours from symptom onset. In many countries, regional or even national ST-elevation myocardial infarction networks have been organized with the aim of minimizing treatment delays.

Methods

In 2005 data on the incidence, demographics, treatment strategies and delays were collected for consecutive ST-elevation myocardial infarction patients in four hospital districts during a six-month period.

Results

The incidence of hospitalization for ST-elevation myocardial infarction in the whole study population was 60 per 100.000 inhabitants. The median age of the study population was 71 years. The mean delay from symptom onset to first medical contact was 75 minutes, with this delay doubled in the patients who sought help on their own initiative compared to those who called an ambulance. Thrombolytic therapy alone was the preferred reperfusion therapy in 63% of the patients, and 82% of the patients received either thrombolytic therapy or primary percutaneous intervention. Initiation of thrombolytic therapy within 30 minutes, according to guidelines, was achieved in 36% of the patients, and correspondingly, every fourth patient had primary percutaneous intervention within 90 minutes,

Conclusions

In general, the rate of reperfusion therapy was acceptable and the preferred mode of therapy was fibrinolysis; this is not in accordance with international guidelines. Regional networks to improve quality of care of ST-elevation myocardial infarction are needed. The aim of the networks should be to provide therapy that is as equal as possible to all patients irrespective of place of living and time of symptom onset. The relatively small number of patients and long distances pose challenges to the development of a 24/7 service covering the whole country.