Impact of the Romanian national programme for interventional therapy in ST-elevation myocardial infarction

Abstract

A national programme for PPCI in STEMI patients was started in Romania in August 2010, based on an integrated and well-trained pre-hospital emergency medical system. Ten national centres experienced in PPCI were organised in a 24/7 system in five regional networks, in order to assist STEMI patients from areas offering PPCI within the first two hours after the first medical contact. For centres located further away, a strategy of local thrombolysis followed by transfer to the closest PCI centre was recommended. The total number of PPCI procedures increased from 1,289 in 2010 to 4,209 in 2011. The percentage of PPCI increased from 25.0% in 2010 to 49.32% in 2011. From 40 PPCI/million inhabitants in 2009, we reached 64/million in 2010 and 210/ million in 2011. In the Bucharest area there were 640 PPCI/ million in 2011. The global in-hospital mortality decreased from 13.5% in 2009 to 9.93% in 2011. In 2011 in-hospital mortality was 4.39%, 8.32% and 17.11% for PPCI, thrombolysis and no-reperfusion, respectively. In-hospital mortality was 7.28% in the PCI centres but 14.20% in centres without PCI facilities. The national programme for PPCI had a major impact on STEMI in-hospital mortality in Romania.

Acute Myocardial Infarction Mortality Rates and Trends in Romania between 1994 and 2017

“…In a paper published in 2010, regarding the situation in Europe between 2007 and 2008, Romania still predominantly used thrombolysis, with only 5% PCI use [8]. By 2010, the PCI rate was still 25%, but after the introduction of the national PCI program, it reached 49.32% in 2011 [9]. However, the data indicates an increase in PCI utilization from 1.9% to 25% between 2000 and 2010.…”

Mortality predictors after percutaneous coronary intervention – a prospective single-center registry study

“…The short-term clinical evolution of patients treated by PCI in Romania is well documented, most of the studies reporting in-hospital-or 30-day mortality as a clinical outcome [3][4][5][6][7][8][9][10][11] . However, contemporary data regarding long term mortality of CAD treated by PCI is mainly lacking in Romania: a few studies evaluated this subject, and only for special PCI indications, such as acute ST-elevation myocardial infarction (STEMI; 1-year follow-up) 12,13 or STEMI complicating left main CAD (1-and 3-year follow-up) 14,15 .…”

Efficiency of Invasive Revascularization for Acute Coronary Syndrome With St Elevation

“…По резуль-татам крупных рандомизированных клинических исследований (DANAMI-2, PAMI-Stent, PRAGUE-2), при сравнении результатов реваскуляризации миокарда при ОКСпST наиболее предпочтительной оказалась инвазивная реваскуляризация миокарда, при которой кровоток восстанавливается в ≥ 90 % случаев [3,12]. В настоящее время проводятся следующие виды эндо-васкулярного вмешательства: первичная реваскуля-ризация -без предшествовавшей тромболитической терапии; спасительная реваскуляризация -после неудачного тромболизиса; отсроченная реваскуля-ризация -через 1-7 дней после тромболизиса [6,14]. Выбор вида реваскуляризации на догоспитальном этапе зависит от доступности Центра чрескожных вмешательств (ЧКВ) в пределах временного интер-вала 120 мин [5].…”