stent for life initiative
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Stent for Life Initiative. Symposium Stent for Life Casa del Corazón,MadridTRANSCRIPT
Stent for Life Initiative
Zuzana KaifoszovaPetr Widimsky
Symposium Stent for Life Casa del Corazón,Madrid
June 10, 2010
Recommendations Class LOE• PPCI for STEMI (within 2 hours)
• Rescue PCI for failed fibrinolysis (within 12 hours)
• PCI for STEMI with shock and contraindications to fibrinolytic therapy irrespective of time delay
• Angiography and PCI after successful fibrinolysis (within 24 hours)
• Urgent PCI for hemodynamically unstable NSTE-ACS (within 2 hours)
• Early PCI for high-risk NSTE-ACS (within 72 hours)
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IIa
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IIa
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A
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B
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C
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ESC Guidelines: PCI for acute CAD
Stent for Life Initiative European Executive Board
• Petr Widimsky/ SFL project co-chairman• Jean Fajadet /SFL project co-chairman • Nicolas Danchin (WG Acute Cardiac Care)• Carlo Di Mario (EAPCI President)• William Wijns (EAPCI Past President) • Steen Kristensen (ESC) • Marielle de la Torre (EAPCI Executive Officer)• Zuzana Kaifoszova (SFL Project Manager, Europe)
Stent for Life InitiativePhase I
Situation Mapping & Data Collection
Annual incidence of hospital admissions for STEMIRef. P.Widimsky, European Heart Journal, doi:10.1093/eurheartj/ehp492
020406080
100120140160
STEMITR PL DE IT GR PT AT ES HU FIN LIT NO SRBHR IL SK CZ SE BE BG LAT SLO FR RO UK
82 / 100 000 inhabitants / year(190 / 100 000 / year for all AMIs)
9286 81 81
75 75 72 70 66 64 5949 45 45
35 33 30 30 28 24 23 19 199 8 5
10 7 2 12
53
15
8 1031
1515
40
3528
2635
30
55
2544
3341
2945
714 12 17 13
20 2515
26 26
10
36 40
15
3039 44
3542
21
52
3748 50
6350
0%10%20%30%40%50%60%70%80%90%
100%
CZ SLO DE CH NO DK PL HR SE HU BE IL IT FIN AT FR SK ES LAT UK BG PO SRB GR TR RO
P-PCI Thrombolysis No reperfusion
Reperfusion Therapies Differ in Countries
P.Widimsky et al. November 19, 2009. Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries. Eur. Heart.J.doi:10.1093/eurheartj/ehp492
≥600 p-PCI / million / year400-599 p-PCI / million / year200-399 p-PCI / million / year<200 p-PCI / million / yearData not known
Annual Incidence of Primary PCIs
PCI’s (all) / million / year
0500
100015002000250030003500400045005000
PCI / million / year
CH DE IL LAT NO A IT NL CZ SE BE PL FR DKHU GR FIN SLO ES UK LIT SK TR PT HR SRB BG RO
1871
Primary PCI’s / million / year
0100200300400500600700800900
1000
PCI / million / year
CH DE PL CZ SE HU NO SLO DK IL A LIT IT SKBE HR FR LAT PT ES SRB FIN UK BG GR TR RO
378
% of primary PCIs among all PCIs (measure of cathlab effectivity ??)
05
10152025303540
p-PCILIT PL SK CZ HU SLO SE DK HR NO DE CH PT SRBAT BG IT IL BE FR ES UK FIN TR RO LAT GR
20% of all PCIs are p-PCIs for STEMI
Mean population per one PCI center
0200 000400 000600 000800 000
1 000 0001 200 0001 400 0001 600 0001 800 0002 000 000
IT GR CH AT BE FR SE IL ES SLO PLBG TR CZ UK HU DK SRB RO
518 698
Population per one primary PCI (24/7) center
0
500 000
1 000 000
1 500 000
2 000 000
2 500 000
3 000 000
FR BE IT IL CZ PL AT SE HU ES BGSLO DK LIT TR GR UK
917 614
Only 55% of all PCI centers offer non-stop 24/7 p-PCI service
0
20
40
60
80
100
CZ FR BE HU HR PL NO CH ILDE AT DK IT SK BG LIT PT SEES SLO GR UK TR LAT SRB FIN RO
55%
Number of PCIs does not correlate to Countries’ GDP
Number of primary PCIs does not correlate to Countries’ GDP
Only 51% STEMI patients arrive to the first hospital by EMS
0102030405060708090
% STEM I arriving via EM S
UKSwedenAustriaCzech Rep.IzraelSerbiaSpainSlovakiaItalyTurkeyG reece
STEMI Mortality per Treatment
9,18,3
4,7
0123456789
10
All STEMI
ThrombolysisPrimary PCI
Nationwide „thrombolytic strategy“ for STEMI results in 46% untreated patients
20
46
05
101520253035404550
No reperfusion used
Countries with p-PCIdominance
Countries withthrombolysisdominance
% from all STEMI
Reperfusion Strategy Paradox
• Most people think, that thrombolysis is a kind of treatment widely available for patients everywhere, while p-PCI is limited in its availability.
• The opposite is true: far more patients receive reperfusion treatment in countries with low use of thrombolysis and high use of p-PCI
Summary
• Most North, West and Central European countries use p-PCI for the majority of their STEMI patients.
• The lack of organised p-PCI networks is associated with fewer patients overall receiving some form of reperfusion therapy.
• Primary PCI rates > 600 per million are needed to provide this treatment for most STEMI patients in Europe.
Stent for Life Initiative Objectives
1. Define regions/countries with an unmet medical need in the optimal treatment of ACS.
2. Implement an action program to increase patient access to primary PCI where indicated:
To increase the use of primary PCI to more than 70% among all ST segment elevation myocardial infarction patients,
To achieve primary PCI rates of more than 600 per one million inhabitants per year,
To offer 24/7 service for primary PCI procedures at all invasive facilities to cover the country STEMI population need.
Stent for Life IntiativePhase II
Learning the experience from the best practice countries
How Can We Improve Networks and Infrastructure
• Regional network (EMS, non-PCI hospitals and PCI centers) should cover an area with population around 0,5 million (cca 0,3 – 1 million).
• Respect the right of local hospitals to take care for the patients after primary PCI is completed and the patient is stabilized (tertiary transport to the local hospital nearest to patient’s home).
• All PCI centers should provide non-stop (24/7) services for primary PCI. PCI hospitals, which are not able to provide non-stop (24/7) primary PCI services, should not be part of the network.
J.Knot:How to set up an effective national primary angioplasty network: lessons learned from five European countries (EuroIntervention, August 2009).
How Can We Improve Emergency Medical Services (EMS)
• EMS staff training is more important that the EMS staff structure (trained nurses suitable for the triage and transport of AMI patients)
• EMS ambulances: equipped by resuscitation facilities and by a portable 12-leads ECG.
• ECG teletransmission (to the PCI center) can be left on the local decision, is not mandatory.
• Road transport is prefferred (air transport takes usually more time).
• Helicopter transport is generally faster in mountainous, islandic or very scarsely populated regions.
J.Knot:How to set up an effective national primary angioplasty network: lessons learned from five European countries (EuroIntervention, August 2009).
How Can We Improve Transport & Time Delays Primary transport should bypass the nearest non-PCI
hospital and the Emergency Room or Intensive Care Unit of the PCI center.
• Immediately diagnostic ECG call to cathlab and start transfer. The ECG – cathlab time <90 minutes can be achieved in vast majority of patients.
• Admission to Emergency Room (or ICU) in the PCI center delays reperfusion by at least 20-40 minutes.
• Admission to non-PCI hospital followed by the „secondary transport“ to PCI center delays reperfusion by at least 30-60 minutes.
J.Knot:How to set up an effective national primary angioplasty network: lessons learned from five European countries(EuroIntervention, August 2009).
Stent for Life IntiativePhase III
Implementation in Countries
Stent for Life Initiative
Declaration was signed at the ESC/EAPCI
General Assembly on Aug 31, 2009
• Turkey (78 p-PCI / mil. / yr.)
• Greece (95 p-PCI / mil. / yr.)
• Bulgaria (130 p-PCI / mil. / yr.)
• Serbia (157 p-PCI / mil. / yr.)
• Spain (165 p-PCI / mil. / yr.)
• France (231 p-PCI / mil. / yr.)
Stent for Life InitiativeSpain
SFL National LeaderDr. Manel Sabate