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Stent for life initiative
September 01, 2009Primary angioplasty (with stent implantation) is the most effective therapy for acute myocardial infarction (AMI), but it is not available to many patients, even though most European countries have sufficient resources (ie, catheterisation laboratories) for its wider use. The Stents 4 Life initiative was a study aiming to analyze the use of primary angioplasty in the treatment of AMI in 27 European countries.
Data were collected from national infarction or angioplasty registries, on AMI epidemiology and treatment and on angioplasty centres and procedures in each country.
Findings showed that the frequency (annual incidence) of hospital admission for any AMI varied between 90 and 312 events per 100,000 population per year; the incidence of serious AMIs (with ST-elevations on ECG - STEMI) ranging from 44-142 per thousand.
Primary angioplasty (primary PCI) was the dominant reperfusion strategy in 17 countries and thrombolysis in nine countries. The application of a PCI strategy varied between 5 and 92% (in all STEMI patients), and use of thrombolysis (an older, less effective form of therapy) between 0 and 55%. Curent guidelines recopmmend that any reperfusion treatment (angioplasty or thrombolysis) should be used ideally in 100% of these patients; however, we found it used only in 37󈟉% of STEMI patients.
The number of primary angioplasty procedures per million population per year varied among countries between 20 and 970. The mean population served by a single primary angioplasty centre varied between 0.3 and 7.4 million inhabitants. In those coutries offering primary angioplasty services to most of their STEMI patients, population varied between 0.3 and 1.1 million per centre.
In-hospital mortality of all consecutive STEMI patients varied between 4.2 and 13.5%, of patients treated by thrombolysis between 3.5 and 14%, and of patients treated by primary PCI between 2.7 and 8%.
The time reported from symptom onset to the first medical contact (FMC) varied between 60 and 210 minutes, FMC to needle time for thrombolysis between 30 and 110 minutes, and FMC to balloon time for primary angioplasty between 60 and 177 minutes.
Most north, west and central European countries used primary angioplasty for the majority of their STEMI patients. The lack of organised primary angioplasty networks in some countries was associated with fewer patients overall receiving some form of reperfusion therapy. Primary angioplasty rates above 600 per million population are needed to provide this treatment for most STEMI patients in Europe.
European Society of Cardiology
Primary angioplasty (primary PCI) was the dominant reperfusion strategy in 17 countries and thrombolysis in nine countries. The application of a PCI strategy varied between 5 and 92% (in all STEMI patients), and use of thrombolysis (an older, less effective form of therapy) between 0 and 55%. Curent guidelines recopmmend that any reperfusion treatment (angioplasty or thrombolysis) should be used ideally in 100% of these patients; however, we found it used only in 37󈟉% of STEMI patients.
The number of primary angioplasty procedures per million population per year varied among countries between 20 and 970. The mean population served by a single primary angioplasty centre varied between 0.3 and 7.4 million inhabitants. In those coutries offering primary angioplasty services to most of their STEMI patients, population varied between 0.3 and 1.1 million per centre.
In-hospital mortality of all consecutive STEMI patients varied between 4.2 and 13.5%, of patients treated by thrombolysis between 3.5 and 14%, and of patients treated by primary PCI between 2.7 and 8%.
The time reported from symptom onset to the first medical contact (FMC) varied between 60 and 210 minutes, FMC to needle time for thrombolysis between 30 and 110 minutes, and FMC to balloon time for primary angioplasty between 60 and 177 minutes.
Most north, west and central European countries used primary angioplasty for the majority of their STEMI patients. The lack of organised primary angioplasty networks in some countries was associated with fewer patients overall receiving some form of reperfusion therapy. Primary angioplasty rates above 600 per million population are needed to provide this treatment for most STEMI patients in Europe.
European Society of Cardiology
Angioplasty Current Events and Angioplasty News RSSYour Own Stem Cells Can Treat Heart Disease
The largest national stem cell study for heart disease showed the first evidence that transplanting a potent form of adult stem cells into the heart muscle of subjects with severe angina results in less pain and an improved ability to walk. The transplant subjects also experienced fewer deaths than those who didn't receive stem cells.
Vitamin B niacin offers no extra benefit to statin therapy in seniors already diagnosed with CAD
The routine prescription of extended-release niacin, a B vitamin (1,500 milligrams daily), in combination with traditional cholesterol-lowering therapy offers no extra benefit in correcting arterial narrowing and diminishing plaque buildup in seniors who already have coronary artery disease, a new vascular imaging study from Johns Hopkins experts shows.
The heart attack myth: Study establishes that women do have same the heart attack symptoms as men
The gender difference between men and women is a lot smaller than we've been led to believe when it comes to heart attack symptoms.
Lifestyle changes remain important in fighting peripheral arterial disease
Modifying the risk of peripheral arterial disease (or PAD)-with healthy lifestyle changes-remains vital to one's health, note researchers in a recent issue of the Journal of Vascular and Interventional Radiology.
Study questions need for routine intervention in patients with renovascular disease
Some invasive procedures that are becoming increasingly common as a first line of treatment for patients diagnosed with narrowed arteries in and around the kidneys may not be necessary.
Designing drugs and their antidotes together improves patient care
Imagine a surgical patient on a blood-thinning drug who starts bleeding more than expected, and an antidote that works immediately - because the blood thinner and antidote were designed to work together.
Pre-hospital organization: The first links in the chain of survival for heart attack patients
Mortality rate following a heart attack has fallen by more than 50% in Europe over the past 25 years. However, because only minor advances in the medical treatment of AMI are expected over the next decade, it is through organisational changes in the pre-hospital phase that mortality rate will continue this decline to below 5%.
Otamixaban for the treatment of patients with non-ST-elevation acute coronary syndromes
Data from a phase II trial of an investigational intravenous drug designed to block the formation of blood clots shows potential to reduce the risk of death, a second heart attack, or other coronary complications compared with the current standard of care in patients presenting with acute coronary syndromes (heart attacks or unstable angina).
New strategies for reperfusion therapy
A new trial has begun in order to ascertain once and for all whether the best strategy for patients who cannot receive P-PCI is early fibrinolysis, together with mandated angiography.
Genetic variation associated with poorer response, cardiovascular outcomes with use of clopidogrel
Patients with a certain genetic variation who received the antiplatelet drug clopidogrel had a decreased platelet response to treatment and among those who had percutaneous coronary intervention (procedures such as balloon angioplasty or stent placement used to open narrowed coronary arteries) had an increased risk of having a cardiovascular event in the following year than patients who did not have this variant, according to a study in the August 26 issue of JAMA.
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