Implementation of Guidelines Improves the Standard of Care

Abstract

Background-The purpose of this study was to determine whether implementation of recent guidelines improves in-hospital mortality from acute ST-elevation myocardial infarction (STEMI) in a metropolitan area. Methods and Results-We organized a network that consisted of the Viennese Ambulance Systems, which is responsible for diagnosis and triage of patients with acute STEMI, and 5 high-volume interventional cardiology departments to expand the performance of primary percutaneous catheter intervention (PPCI) and to use the fastest available reperfusion strategy in STEMI of short duration (2 to 3 hours from onset of symptoms), either PPCI or thrombolytic therapy (TT; prehospital or in-hospital), respectively. Implementation of guidelines resulted in increased numbers of patients receiving 1 of the 2 reperfusion strategies (from 66% to 86.6%). Accordingly, the proportion of patients not receiving reperfusion therapy dropped from 34% to 13.4%, respectively. PPCI usage increased from 16% to almost 60%, whereas the use of TT decreased from 50.5% to 26.7% in the participating centers. As a consequence, in-hospital mortality decreased from 16% before establishment of the network to 9.5%, including patients not receiving reperfusion therapy. Whereas PPCI and TT demonstrated comparable in-hospital mortality rates when initiated within 2 to 3 hours from onset of symptoms, PPCI was more effective in acute STEMI of Ͼ3 but Ͻ12 hours' duration. Conclusions-Implementation of recent guidelines for the treatment of acute STEMI by the organization of a cooperating network within a large metropolitan area was associated with a significant improvement in clinical outcomes.

Implementation of a Regional Network for ST‐Segment–Elevation Myocardial Infarction (STEMI) Care and 30‐Day Mortality in a Low‐ to Middle‐Income City in Brazil: Findings From Salvador's STEMI Registry (RESISST)

“…The results of the CAPTIM (Comparison of Primary Angioplasty and Pre‐hospital Fibrinolysis in Acute Myocardial Infarction) study indicated that prehospital fibrinolysis, particularly in the first 2 hours after symptoms onset, can be more effective than transfer for primary PCI 20. In fact, 2 major registries—the Vienna STEMI Registry21 and the French Registry on Acute ST‐Elevation and Non‐ST‐elevation Myocardial Infarction (FAST‐MI) 201022—showed similar results for patients treated at an early stage.…”

Effectiveness of regionalized systems for stroke and myocardial infarction

“…(2013) in Denmark, Kalla et al. (2006) in Austria, Danchin et al. (2008) in France, and Le May et al.…”

Management of acute coronary syndrome: achievements and goals still to pursue. Novel developments in diagnosis and treatment

“…Therefore, several strategies have been developed to minimize the delay. In addition to inhospital and outpatient frameworks, educational programmes for timely medical care-seeking behaviour and prehospital protocols have been designed to improve outcomes [13][14][15][16]. Although the cause of prehospital delay in ACS is multifactorial and the duration from onset of symptoms until care-seeking is in part dependent on nonadjustable (patient) characteristics [17], some factors that cause delay in reperfusion after medical care-seeking are modifiable.…”