Acta clinica Croatica, Vol. 54. No. 3., 2015.
Review article
Seven-Year Trends in the Croatian Primary Percutaneous Coronary Intervention Network
Zdravko Babić
orcid.org/0000-0002-7060-8375
; Sestre milosrdnice University Hospital Center, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
Hrvoje Pintarić
; Sestre milosrdnice University Hospital Center, Zagreb, Croatia; School of Dental Medicine, University of Zagreb, Zagreb, Croatia
Boris Starčević
; Dubrava University Hospital, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
Joško Bulum
; Zagreb University Hospital Center, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
Vjekoslav Tomulić
; Rijeka University Hospital Center, Rijeka, Croatia
Lovel Giunio
; Split University Hospital Center, Split, Croatia
Ivo Vuković
; Split University Hospital Center, Zagreb, Croatia; School of Medicine, University of Split, Split, Croatia
Robert Steiner
; Osijek University Hospital Center, Osijek, Croatia; School of Medicine, Josip Juraj Strossmayer University, Osijek, Croatia
Hrvoje Stipić
; Magdalena Special Hospital for Cardiovascular Diseases, Krapinske Toplice, Croatia
Jozica Šikić
; Sveti Duh University Hospital, Zagreb, Croatia; School of Medicine, University of Zagreb, Zagreb, Croatia
Dražen Zekanović
; Zadar General Hospital, Zadar, Croatia
Deiti Prvulović
; Dr Josip Benčević General Hospital, Slavonski Brod, Croatia
Damir Kozmar
; Merkur University Hospital, Zagreb, Croatia
Davor Miličić
Abstract
The authors investigated trends in the Croatian primary Percutaneous Coronary Intervention (pPCI) Network results among three consecutive time intervals (2005-2007, first phase; 2008-2009, second phase; and 2010-2011, third phase). Data on 5650 patients with acute myocardial infarction with ST-elevation (STEMI ) transferred or directly admitted and treated with pPCI in 11 Croatian PCI centers during the study period were collected and analyzed. The number of patients with acute STEMI treated with pPCI per year rose continuously during the study period (581 vs.1272 vs. 1949 patients/year). The patient risk profile worsened during the study period: age (60 vs. 61 vs. 63 years; p<0.01), anterior myocardial wall involvement (43% vs. 44% vs. 51%; p<0.01), shock rate (7% vs. 9% vs. 11%; p<0.05), and percentage of transferred patients (42% vs. 36% vs. 46%; p<0.01). While the door-to-balloon time shortened (108 vs. 98 vs. 75 min; p<0.01), the symptom onset-to-door time increased (130 vs. 175 vs. 195 min; p<0.01), but without statistically significant influence on the total ischemic time. Multivariate log-linear analysis eliminated influence of a higher risk profile on the results of treatment and yielded no statistically significant changes in final TIMI 3 flow (Thrombolysis In Myocardial Infarction 3), in-hospital mortality, and six-month mortality rate, but revealed a significant increase in the rate of angina pectoris (12 vs. 22 vs. 36%; p<0.01) and other major adverse cardiovascular events (MACE; 6 vs. 23 vs. 14%; p<0.01) during follow up. In conclusion, the Croatian pPCI Network continuously ensures very good results of STEMI treatment in this economically less developed European country despite worsening of the risk profile in treated patients and opening of new, less experienced PCI centers. The higher percentage of MACE over time could be explained by changes in the pPCI strategy introduced over time (the culprit lesion only) and higher availability of PCI centers for additional PCI after acute STEMI. However, there is room for improvement, especially in reducing prehospital delay.
Keywords
Myocardial infarction – therapy; Coronary disease – therapy; Percutaneous coronary intervention; Croatia
Hrčak ID:
148938
URI
Publication date:
1.11.2015.
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