학술논문
Care of patients with ST-elevation myocardial infarction: an international analysis of quality indicators in the acute coronary syndrome STEMI Registry of the EURObservational Research Programme and ACVC and EAPCI Associations of the European Society of Cardiology in 11 462 patients.
Document Type
Academic Journal
Author
Ludman P; Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK.; Zeymer U; Klinikum der Stadt Ludwigshafen and Institut für Herzinfarktforschung, Ludwigshafen am Rhein, Germany.; Danchin N; Hôpital Européen Georges Pompidou, Service de Cardiologie Paris, Paris, France.; Kala P; Department of Internal Medicine and Cardiology, Medical Faculty of Masaryk University, University Hospital Brno, Brno, Czech Republic.; Laroche C; EURObservational Research Programme, European Society of Cardiology, Sophia Antipolis, France.; Sadeghi M; Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.; Caporale R; Interventional Cardiology Unit, Annunziata Civil Hospital, Cosenza, Italy.; Shaheen SM; Ain Shams University, Cairo, Egypt.; Legutko J; Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Krakow, Poland.; Iakobishvili Z; Rabin Medical Center, Petah Tikva, Israel.; Alhabib KF; Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University, Riyadh, Saudi Arabia.; Motovska Z; Cardiocenter, Third Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic.; Studencan M; Cardiocentre Presov, Teaching Hospital of J.A. Reiman, Presov, Slovakia.; Mimoso J; Centro Hospitalar e Universitário do Algarve, Faro, Portugal.; Becker D; Heart and Vascular Center, Semmelweis University, Budapest, Hungary.; Alexopoulos D; National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.; Kereseselidze Z; Chapidze Emergency Cardiology Center, Tbilisi, Georgia.; Stojkovic S; Faculty of Medicine, University of Belgrade, Belgrade, Serbia.; Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.; Zelveian P; Scientific Research Institute of Cardiology named after Levon Hovhannisyan, Yerevan, Armenia.; Goda A; Cardiology I and Cardiology II, University Hospital Center Mother Theresa, Tirana, Albania.; Mirrakhimov E; Kyrgyz State Medical Academy, Bishkek, Kyrgyzstan.; National Center of Cardiology and Internal Medicine, Bishkek, Kyrgyzstan.; Bajraktari G; Medical Faculty, University of Prishtina 'Hasan Prishtina', University Clinical Centre of Kosova, Prishtina, Kosovo.; Farhan HA; Iraqi Board for Medical Specializations, Scientific Council of Cardiology, Baghdad Heart Centre, Medical City, Baghdad, Iraq.; Šerpytis P; Vilnius University Faculty of Medicine, Vilnius, Lithuania.; Raungaard B; Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.; Marandi T; Centre of Cardiology, North Estonia Medical Centre, Tallinn, Estonia.; Department of Cardiology, University of Tartu, Tartu, Estonia.; Moore AM; Mater Dei Hospital, Msida, Malta.; Quinn M; St Vincent's University Hospital, Dublin 4, Ireland.; Karjalainen PP; Heart and Lung Center, Helsinki University Hospital and Helsinki University, Helsinki, Finland.; Tatu-Chitoiu G; Spitalul Clinic de Urgenta 'Floreasca', Bucharest, Romania.; Gale CP; EURObservational Research Programme, European Society of Cardiology, Sophia Antipolis, France.; Department of Cardiology, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, Leeds, UK.; Maggioni AP; EURObservational Research Programme, European Society of Cardiology, Sophia Antipolis, France.; ANMCO Research Center, Heart Care Foundation, Florence, Italy.; Weidinger F; Hospital Rudolfstiftung, Vienna, Austria.
Source
Publisher: Oxford University Press Country of Publication: England NLM ID: 101591369 Publication Model: Print Cited Medium: Internet ISSN: 2048-8734 (Electronic) Linking ISSN: 20488726 NLM ISO Abbreviation: Eur Heart J Acute Cardiovasc Care Subsets: MEDLINE
Subject
Language
English
Abstract
Aims: To use quality indicators to study the management of ST-segment elevation myocardial infarction (STEMI) in different regions.
Methods and Results: Prospective cohort study of STEMI within 24 h of symptom onset (11 462 patients, 196 centres, 26 European Society of Cardiology members, and 3 affiliated countries). The median delay between arrival at a percutaneous cardiovascular intervention (PCI) centre and primary PCI was 40 min (interquartile range 20-74) with 65.8% receiving PCI within guideline recommendation of 60 min. A third of patients (33.2%) required transfer from their initial hospital to one that could perform emergency PCI for whom only 27.2% were treated within the quality indicator recommendation of 120 min. Radial access was used in 56.6% of all primary PCI, but with large geographic variation, from 76.4 to 9.1%. Statins were prescribed at discharge to 98.7% of patients, with little geographic variation. Of patients with a history of heart failure or a documented left ventricular ejection fraction ≤40%, 84.0% were discharged on an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and 88.7% were discharged on beta-blockers.
Conclusion: Care for STEMI shows wide geographic variation in the receipt of timely primary PCI, and is in contrast with the more uniform delivery of guideline-recommended pharmacotherapies at time of hospital discharge.
Competing Interests: Conflict of interest: P.L., C.L., M.S., S.M.S., J.L., K.F.A., A.G., E.M., G.B., H.A.F., P.Š., M.S., J.M., D.B, D.A., Z.K., S.S., A.M.M., M.Q., and P.P.K. have nothing to disclose. U.Z. reports: Consulting fees from Amgen, personal fees from Amgen; payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from Astra Zeneca, Chiesi, Pfizer; participation on a Data Safety Monitoring Board or Advisory Board Astra Zeneca, Chiesi, Bayer, Boehriger Ingelhein, outside the submitted work. R.C. reports participation on a Data Safety Monitoring Board or Advisory Board with personal payments from Daiichi Sankyo, Novartis, Boehringer Ingelheim, Lilly, outside the submitted work. Z.I. reports consulting fees with direct payments to author from Pfizer, Astra Zeneca, Bayer; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Novartis, Sanofi, Boehringer Ingelheim outside the submitted work. Z.M. reports consulting fees from Amgen; payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from Astra Zeneca, Chiesi, Pfizer; participation on a Data Safety Monitoring Board or Advisory Board from Astra Zeneca, Chiesi, Bayer, Boehriger Ingelhein outside the submitted work. T.M. reports receipt of funding from Estonian Research Council [PRG435]; payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, or educational events from AstraZeneca, Eesti outside the submitted work. C.P.G. reports grants or contracts from British Heart Foundation, National Institute for Health Research, Horizon 2020, Abbott Diabetes, Bristol Myers Squibb/Pfizer; consulting fees from Amgen, AstraZeneca, Bayer, Bristol Myers Squibb, Boehringer Ingelheim, Chiesi, Daiichi Sankyo, Menarini; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events fromBoehringer Ingelheim, Chiesi, Daiichi Sankyo, Menarini; support for attending meetings and/or travel from AstraZeneca, Bayer; patents planned, issued, or pending—FIND-AF; participation on a Data Safety Monitoring Board or Advisory Board—TARGET CTCA DSMB, DANBLOCK DSMB; leadership or fiduciary role in other board, society, committee, or advocacy group, for ESC EuroHeart, NICE IAC, ESC Quality Indicator Committee Chair, outside the submitted work. A.P.M. reports payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events—AstraZeneca, Novartis; participation in study committees—Bayer, Fresenius, outside the present work.
(© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)
Methods and Results: Prospective cohort study of STEMI within 24 h of symptom onset (11 462 patients, 196 centres, 26 European Society of Cardiology members, and 3 affiliated countries). The median delay between arrival at a percutaneous cardiovascular intervention (PCI) centre and primary PCI was 40 min (interquartile range 20-74) with 65.8% receiving PCI within guideline recommendation of 60 min. A third of patients (33.2%) required transfer from their initial hospital to one that could perform emergency PCI for whom only 27.2% were treated within the quality indicator recommendation of 120 min. Radial access was used in 56.6% of all primary PCI, but with large geographic variation, from 76.4 to 9.1%. Statins were prescribed at discharge to 98.7% of patients, with little geographic variation. Of patients with a history of heart failure or a documented left ventricular ejection fraction ≤40%, 84.0% were discharged on an angiotensin-converting enzyme inhibitor/angiotensin receptor blocker and 88.7% were discharged on beta-blockers.
Conclusion: Care for STEMI shows wide geographic variation in the receipt of timely primary PCI, and is in contrast with the more uniform delivery of guideline-recommended pharmacotherapies at time of hospital discharge.
Competing Interests: Conflict of interest: P.L., C.L., M.S., S.M.S., J.L., K.F.A., A.G., E.M., G.B., H.A.F., P.Š., M.S., J.M., D.B, D.A., Z.K., S.S., A.M.M., M.Q., and P.P.K. have nothing to disclose. U.Z. reports: Consulting fees from Amgen, personal fees from Amgen; payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from Astra Zeneca, Chiesi, Pfizer; participation on a Data Safety Monitoring Board or Advisory Board Astra Zeneca, Chiesi, Bayer, Boehriger Ingelhein, outside the submitted work. R.C. reports participation on a Data Safety Monitoring Board or Advisory Board with personal payments from Daiichi Sankyo, Novartis, Boehringer Ingelheim, Lilly, outside the submitted work. Z.I. reports consulting fees with direct payments to author from Pfizer, Astra Zeneca, Bayer; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Novartis, Sanofi, Boehringer Ingelheim outside the submitted work. Z.M. reports consulting fees from Amgen; payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events from Astra Zeneca, Chiesi, Pfizer; participation on a Data Safety Monitoring Board or Advisory Board from Astra Zeneca, Chiesi, Bayer, Boehriger Ingelhein outside the submitted work. T.M. reports receipt of funding from Estonian Research Council [PRG435]; payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing, or educational events from AstraZeneca, Eesti outside the submitted work. C.P.G. reports grants or contracts from British Heart Foundation, National Institute for Health Research, Horizon 2020, Abbott Diabetes, Bristol Myers Squibb/Pfizer; consulting fees from Amgen, AstraZeneca, Bayer, Bristol Myers Squibb, Boehringer Ingelheim, Chiesi, Daiichi Sankyo, Menarini; payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events fromBoehringer Ingelheim, Chiesi, Daiichi Sankyo, Menarini; support for attending meetings and/or travel from AstraZeneca, Bayer; patents planned, issued, or pending—FIND-AF; participation on a Data Safety Monitoring Board or Advisory Board—TARGET CTCA DSMB, DANBLOCK DSMB; leadership or fiduciary role in other board, society, committee, or advocacy group, for ESC EuroHeart, NICE IAC, ESC Quality Indicator Committee Chair, outside the submitted work. A.P.M. reports payment or honoraria for lectures, presentations, speakers’ bureaus, manuscript writing or educational events—AstraZeneca, Novartis; participation in study committees—Bayer, Fresenius, outside the present work.
(© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)