Implementation of guidelines improves the standard of care : The viennese registry on reperfusion strategies in ST-elevation myocardial infarction (vienna STEMI registry)

• Published in: Circulation (New York, N.Y.) N.Y.), 2006-05, Vol.113 (20), p.2398-2405
• Main Authors: KALLA, Karim, CHRIST, Günter, LAGGNER, Anton N, MAURER, Gerald, MLCZOCH, Johannes, SLANY, Joerg, WEBER, Heinrich S, HUBER, Kurt, KARNIK, Ronald, MALZER, Reinhard, NORMAN, Georg, PRACHAR, Herbert, SCHREIBER, Wolfgang, UNGER, Gerhard, GLOGAR, Helmut D, KAFF, Alfred
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty, Balloon, Coronary - standards; Austria - epidemiology; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Coronary heart disease; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Female; Heart; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - epidemiology; Myocardial Infarction - surgery; Myocardial Infarction - therapy; Myocardial Reperfusion - standards; Neurology; Quality Assurance, Health Care; Registries; Retrospective Studies; Shock, Cardiogenic - epidemiology; Time Factors; Vascular diseases and vascular malformations of the nervous system
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/CIRCULATIONAHA.105.586198

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. 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