Survey Reveals Improvements, Gaps in Primary PCI Access Across Europe

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While sizeable improvements have been made in expanding the availability of primary percutaneous coronary intervention (PCI) across Europe, alarming variability remains between countries, according to survey results released August 26, 2012, at the European Society of Cardiology (ESC) Congress in Munich, Germany.

The survey, sponsored by the European Association of Percutaneous Cardiovascular Interventions (a branch of the ESC), was conducted during 2010 to 2011 and included 33 European countries.

“These new data from an EAPCI/ESC survey show huge variation across Europe in the numbers treated with primary PCI,” Steen Dalby Kristensen, MD, DMSc, of Aarhus University (Aarhus, Denmark) said in a press release. “[They] also stress that we need to have good national and European registers to monitor the numbers of patients receiving primary PCI and to monitor patient outcomes including mortality rate.”

The number of primary PCI procedures per million inhabitants per year ranges from 4 to 769 across the surveyed countries.

Other findings from the survey reveal a combination of positive and negative trends.

The Good

In Romania, the total number of primary PCI procedures increased from 1,289 in 2010 to 4,200 in 2011, reflecting a doubling in the percentage of STEMI patients receiving primary PCI (from 25% to 50%). This had a direct impact on in-hospital mortality, which decreased from 13.6% to 5.2% during the period 2009 to 2011.

In Turkey, primary PCI rates reached over 90% across 18 pilot cities, with an effective mean door-to-balloon time of 54.72 minutes.

In Portugal, the percentages of patients receiving primary PCI vs. fibrinolysis shifted heavily in favor of PCI (68% vs. 7%). This translated to 303 primary PCI procedures per million inhabitants, a growth rate of 13% since 2010.

In Bulgaria, the number of primary PCI procedures per million inhabitants rose steadily over the past 5 years, from 88 per million inhabitants in 2007 to 650 in 2011. Over the same time period, total AMI mortality has decreased from 16.3% to 12.7 %, while primary PCI-related AMI mortality remains unchanged at around 5%.

The Not So Good

According to the results, large percentages of the surveyed populations do not know how to recognize signs of STEMI or how to act if they occur, making education of primary importance. However, budget concerns make such initiatives difficult prospects.

Other barriers include insufficient staff (nurses and technicians) for providing 24/7 primary PCI services. For instance, in Turkey, only 57% of primary PCI centers can offer a 24-hour service, 7 days a week. Other unmet needs include:

  • Long delays in ground transportation of patients to hospitals
  • Different organization of patient flow procedures within and between hospitals

In Portugal, only 29% of STEMI patients contacted EMS, while 56% presented to centers without interventional cardiology units, resulting in long transfer times to facilities with such services.

In Bulgaria, total AMI mortality actually rose from 10.4% in 2010 to 12.7% in 2011. This was attributed to symptom awareness issues, prolonged onset-to-door times, and a “negative campaign in the Bulgarian media towards interventional cardiology,” said Julia Jorgova, MD, of University Hospital St. Ekaterina (Sofia, Bulgaria), which she called “a dangerous pitfall [that] discourages a lot of patients from undergoing PCI during STEMI.”

Access problems represent a recurring theme. According to John Kanakakis, MD, of National and Kapodestrian University (Athens, Greece), “There are many people in Greece that live in the islands and in small villages in the mountains with very difficult access to the PCI hospitals. These people are currently transferred by helicopter to the closest big city, but it is not always done fast enough.”

 

Source:

Kristensen SD. Stent for life: Optimising primary percutaneous coronary intervention in Europe. Presented at: European Society of Cardiology Congress. August 26, 2012. Munich, Germany.

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