Management of patients with acute ST-elevation myocardial infarction: Results of the FAST-MI Tunisia Registry

Abstract

Background The FAST-MI Tunisia registry was set up by the Tunisian Society of Cardiology and Cardiovascular Surgery to assess the demographic and clinical characteristics, management and hospital outcome of patients with ST-elevation myocardial infarction (STEMI). Methods Data for 459 consecutive patients (mean age 60.8 years; 88.5% male) with STEMI, treated in 16 public hospitals (representing 72.2% of public hospitals in Tunisia treating STEMI patients), were collected prospectively.The most common risk factors were smoking (63.6%), hypertension (39.7%), diabetes (32%) and dyslipidaemia (18.2%). Results Among the 459 patients, 61.8% received reperfusion therapy: 30% with primary percutaneous coronary intervention (PPCI) and 31.8% with intravenous fibrinolysis (IF) (28.6% with pre-hospital thrombolysis). The median time from symptom onset to thrombolysis was 185 min and to PPCI was 358 min. In-hospital mortality was 5.3%. Compared with those managed at regional hospitals, patients managed at interventional university hospitals ( n = 357) were more likely to receive reperfusion therapy (52.9% vs. 34.1%; p<0.001), with less IF (28.6% vs. 43.1%; p = 0.002) but more PPCI (37.8% vs. 3.9%; p<0.0001). However, in-hospital mortality in the two types of hospitals was similar (5.3% vs. 5.1%; p = 0.866). Conclusions Data from the FAST-MI Tunisia registry show that a pharmaco-invasive strategy of management for STEMI should be promoted in non-interventional regional hospitals.

Intracoronary or intravenous abciximab after aspiration thrombectomy in patients with STEMI undergoing primary percutaneous coronary intervention

“…This was due to the specific area where the study was AFRICA carried out, namely northern Africa. However, similar symptomto-door and symptom-to-balloon times have been reported in registries from Egypt, 25 Tunisia 31 and Morocco. 32 Despite this delay, primary PCI was performed instead of thrombolysis in our study, as it was done in about 35% of patients included in northern African registries.…”

“…32 Despite this delay, primary PCI was performed instead of thrombolysis in our study, as it was done in about 35% of patients included in northern African registries. 25,[31][32][33] We acknowledge that this delay is not optimal to assess the efficacy of an IC delivery of abciximab, an approach expected to improve distal perfusion after recanalisation of the occluded coronary artery. Therefore we cannot exclude any beneficial effect resulting from a shorter delay before primary PCI.…”

Pre‐hospital thrombolysis for ST‐segment elevation myocardial infarction in regional Australia: long‐term follow up

“…PHT has the potential to reduce the burden of STEMI related complications in lower‐ and middle‐income countries where timely STEMI treatment is not available. As to‐date there are no randomised controlled trials evaluating the efficacy of PHT for STEMI in lower‐ and middle‐income countries, currently available data can be extrapolated and can help in establishment of systems of care to provide early treatment to the STEMI patients in these areas . Policy makers should consider their local health infrastructure, population distribution needs and should develop guidelines for PHT in light of the internationally available systems and experiences.…”

Quality evaluation in delivering care of Acute Myocardial Infarction in Sancti-Spirítus, Cuba.

“…However, three patterns may be described. First, in northern African countries, attention seems to be dependent on patient's time for rst medical contact, as technologies and human resources appear to be available [21][22][23] . Second, in sub-Saharan countries attention appears to be really poor, based on absence of reperfusion treatment for most of patients, despite their delay time to seek for attention: few patients received thrombolytic, and a huge variation of system delay was observed, Betablockers and ACE-I administration didn't reach a quarter of available population [24][25][26] .…”