Published online before print May 15, 2006, doi: 10.1161/CIRCULATIONAHA.105.586198
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(Circulation. 2006;113:2398-2405.)
© 2006 American Heart Association, Inc.
Coronary Heart Disease |
Implementation of Guidelines Improves the Standard of Care
The Viennese Registry on Reperfusion Strategies in ST-Elevation Myocardial Infarction (Vienna STEMI Registry)
From Wilhelminenhospital (K.K., G.U., K.H.), 3rd Medical Department, Cardiology and Emergency Medicine; Department of Cardiology (G.C., H.D.G., G.M.), Medical University Vienna; Krankenhaus Rudolfstiftung (R.K., J.S.), 2nd Medical Department, Cardiology; Ambulance Services Vienna (R.M., A.K.); Sozialmedizinisches Zentrum Ost (G.N., H.S.W.), 1st Medical Department, Cardiology; Krankenhaus Lainz (H.P., J.M.), 4th Medical Department, Cardiology; and Department of Emergency Medicine (W.S., A.N.L.), University of Medicine, Vienna, Austria.
Correspondence to Kurt Huber, Director, 3rd Medical Department, Cardiology and Emergency Medicine, Wilhelminenhospital, Montleartstrasse 37, A-1160 Vienna, Austria. E-mail kurt.huber{at}wienkav.at
Received August 31, 2005; revision received January 30, 2006; accepted March 10, 2006.
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 >3 but <12 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.
CLINICAL PERSPECTIVE
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