Background:The Myocardial Infarction Network Essen was initiated in order to establish a standardized procedure with immediate reopening of the infarcted vessel for patients with ST-elevation myocardial infarction (STEMI) in the city of Essen, Germany. The present study aims to evaluate gender-related differences in presentation of disease and clinical outcome. Hypothesis: Gender is associated with differences in presentation and outcome of STEMI. Methods: All patients with STEMI were included without exception. Parameters such as risk profile, mortality, and relevant time intervals were documented. The follow-up period was 1 year. Results: For this study, 1365 patients (72.1% male) were recruited. Women were significantly older, with higher prevalence of diabetes (28.1% vs 20.3%, P = 0.004) and hypertension (76.5% vs 64.8%, P < 0.0005). Analysis of time intervals between symptoms to actions showed no significant differences. However, women tended to wait longer before calling for medical assistance (358 vs 331 min, P = 0.091). In-hospital mortality was comparable with respect to gender, whereas women had higher 1-year mortality (18.6% vs 13.2%). Age and diabetes were associated with a higher mortality. Adjusted for age, gender is no longer an independent risk factor. In the follow-up period, significantly more women were readmitted to the hospital without a difference in the frequency of reangiography, surgery, or target-vessel revascularization. Conclusions: The present data display a successful implementation of a standardized procedure in patients with STEMI. Although differences between genders are not as obvious as expected, efforts should be taken to perform a gender-specific risk analysis as well as to promote education about proper behavior in case of new onset of angina.
IntroductionAlthough gender-related differences in treatment and prognosis of acute myocardial infarction (MI) have been documented for more than a decade, the results are still conflicting. Some investigations have described a generally consistent pattern of less-intensive treatment in acute MI
Current guidelines favor primary percutaneous coronary intervention (PCI) as the strategy of choice for the treatment of acute ST segment elevation myocardial infarction (STEMI). Already in its 1st year, the myocardial infarction network "Herzinfarktverbund Essen" demonstrates with 489 patients the feasibility of an exhaustive urban STEMI network with preference to patient transfer to high-volume PCI centers. Furthermore, integrated health care as an optional part of the "Herzinfarktverbund" offers reimbursement for modern and innovative diagnostic procedures, therapies, and rehabilitation.
Percutaneous coronary intervention (PCI) is superior to thrombolysis treating acute ST segment elevation myocardial infarction (STEMI) and is recommended by guidelines as the preferential treatment, if particular preconditions are fulfilled. The "Herzinfarktverbund Essen" proves that a therapy of STEMI corresponding to guidelines can be offered standardized covering the needs of a city after building the best possible network structure. At the same time, new opportunities of the health care system by a model of integrated medical care are used.
In a German city (Essen, 490,000 people), a new network system for patients with ST elevation myocardial infarction (STEMI) was established in 2004. This included a so-called integrated care model (IV model) by participation of insurance companies. In a cooperative structure between invasive and noninvasive hospitals, general practitioners and cardiologists as well as emergency systems it could be realized, that every patient with STEMI will be treated by primary percutaneous coronary intervention (PCI) as soon as possible according to the current guidelines. The patient characteristics (age, gender, comorbidity, medication) were comparable to other trials and registries. The primary success rate was high (96.4%). The acute in-hospital results demonstrated a low mortality (7.6%). The time periods of delay were comparable to other registries. The symptom-to-balloon time was 239 min, the medical contact-to-balloon time 95 min, the door-to-balloon time 60 min, and the puncture-to-balloon time 18 min (median values). The STEMI network system in Essen demonstrates the possibility of modern therapy in patients with myocardial infarction (primary PCI) in a cooperative modality between all participants in the health-care system.
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