Results of the Croatian Primary Percutaneous Coronary Intervention Network for Patients With ST-Segment Elevation Acute Myocardial Infarction

• Published in: The American journal of cardiology Vol. 105; no. 9; pp. 1261 - 1267
• Main Authors: Nikolić Heitzler, Vjeran, PhD, Babic, Zdravko, MD, Milicic, Davor, PhD, Bergovec, Mijo, PhD, Raguz, Miroslav, MD, Mirat, Jure, PhD, Strozzi, Maja, PhD, Plazonic, Zeljko, MD, Giunio, Lovel, PhD, Steiner, Robert, PhD, Starcevic, Boris, PhD, Vukovic, Ivica, PhD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-05-2010; Elsevier; Elsevier Limited
• Subjects: Adult; Aged; Aged, 80 and over; Angioplasty; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular; Clinical medicine; Coronary heart disease; Croatia - epidemiology; Diseases of the cardiovascular system; Electrocardiography; Female; Follow-Up Studies; Heart; Heart attacks; Hospital Mortality - trends; Humans; Male; Medical sciences; Middle Aged; Mortality; Myocardial Infarction - diagnosis; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Myocarditis. Cardiomyopathies; Prospective Studies; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Socioeconomic factors; Survival Rate - trends; Thrombolytic Therapy - methods; Treatment Outcome; Young Adult; Croatia; Human; Myocardial infarction; Atherectomy; Angioplasty; Acute; Coronary artery; Instrumentation therapy; Cardiovascular disease; Patient; Coronary heart disease; Myocardial disease; Stent; Result; Percutaneous route; ST elevation; Primary; Network; Circulatory system; Cardiology
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2009.12.041

The Republic of Croatia, with a gross domestic product per capita of US$11,554 in 2008, is an economically less-developed Western country. The goal of the present investigation was to prove that a well-organized primary percutaneous coronary intervention network in an economically less-developed country equalizes the prospects of all patients with acute ST-segment elevation myocardial infarction at a level comparable to that of more economically developed countries. We prospectively investigated 1,190 patients with acute ST-segment elevation myocardial infarction treated with primary PCI in 8 centers across Croatia (677 nontransferred and 513 transferred). The postprocedural Thrombolysis In Myocardial Infarction flow, in-hospital mortality, and incidence of major adverse cardiovascular events (ie, mortality, pectoral angina, restenosis, reinfarction, coronary artery bypass graft, and cerebrovascular accident rate) during 6 months of follow-up were compared between the nontransferred and transferred subgroups and in the subgroups of older patients, women, and those with cardiogenic shock. In all investigated patients, the average door-to-balloon time was 108 minutes, and the total ischemic time was 265 minutes. Postprocedural Thrombolysis In Myocardial Infarction 3 flow was established in 87.1% of the patients, and the in-hospital mortality rate was 4.4%. No statistically significant difference was found in the results of treatment between the transferred and nontransferred patients overall or in the subgroups of patients >75 years, women, and those with cardiogenic shock. In conclusion, the Croatian Primary Percutaneous Coronary Intervention Network has ensured treatment results of acute ST-segment elevation myocardial infarction comparable to those of randomized studies and registries of more economically developed countries.