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Inequalities across Europe in access to primary angioplasty to treat acute heart attack patients-the cross-border dimension-John Martin, MD, FRCP, FESC, FMedSciChairman, European Critical Care FoundationProfessor of Cardiovascular Medicine, University College LondonAdjunctProfessor of Medicine, Yale University
Coronary arteries: balloon angioplasty
The European Society of Cardiology (ESC) guidelines recommend primary PCI as the preferred treatment whenever it is available within 90-120 minutes of the first medical contact
Primary PCI vs. Thrombolysis in ST-Elevation Myocardial Infarction:
Meta-analysis (23 Randomised controlled trials, N=7,739)
Short-term Outcomes (4-6 weeks)
Death, Nonfatal, Reinfarction,
Based on Keeley EC, et al. Lancet. 2003;361:13-20.
Maeng,M et al. Am J Cardiol 2010;105:1528 –1534)
Time from symptom onset to treatment predicts 1 Year Mortality—Primary PCI
The relative risk of 1 year mortality increases by 7.5% for each 30 minute delay.
Roughly 1% every 3 minutes
Y=2.86 (± 1.45) + 0.0045X1 + 0.000043X2P<.001
De Luca G, et al. Circulation. 2004;109:1223-1225.
1) Transmission of electrocardiogram from ambulance to STEMI centre (hospital)
2) Hospital doctor makes the STEMI diagnosis and directs the ambulance to the STEMI centre.
Stent for Life InitiativeGuidelines Implementation ModelWilliam Wijns, MD, PhD, FESC, FAHACo-Founder, Stent for Life InitiativeCo-Director, Cardiovascular Centre, O.L.V.Z. Aalst, Belgium
P.Widimsky et al. November 19, 2009. Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries. Eur. Heart.J.doi:10.1093/eurheartj/ehp492
Integrate SFL into National Cardiology Program
Engage all stakeholders e.g. physicians, politicians, payers and patients’ organizations
Build Regional Network and Infrastructure (EMS)
Establish National ACS/AMI Registry
Increase Disease Awareness (Educational campaign to government, payers and lay public)
SFL Member CountriesBulgaria, Cyprus, Egypt, France, Greece, Italy, Portugal, Romania, Serbia, Spain, Turkey, Ukraine, Bosnia and Herzegovina
SFL Affiliate Countries and Organizations
Increase awareness of heart attack symptoms and the urgency of treatment among Europeans
A key barrier in every country is lack of action to urgently call an ambulance as soon as heart attack symptoms are observed
Border regions and access to primaryangioplastyJohn Martin, MD, FRCP, FESC, FMedSciChairman, European Critical Care FoundationProfessor of Cardiovascular Medicine, University College LondonAdjunctProfessor of Medicine, Yale University
Londonderry, N Ireland/Ireland
John Martin: J.Martin@ucl.ac.uk
William Wijns: William.Wijns@olvz-aalst.be