Reperfusion therapy in acute myocardial infarction with ST elevation, comparison of Serbia with other European countries

The only optimal therapy for patients with acute myocardial infarction with ST elevation (STEMI) is urgent reperfusion. Primary percutaneous coronary intervention (pPCI) and thrombolysis (TL) are two alternative reperfusion methods. pPCI is superior to TL in mortality reduction, as well as in reinfarction and stroke reduction. The aim of this study is to illustrate current situation in Serbia with respect to treatment methods for patients with STEMI in comparison to other European countries. Results: The European Association of Percutaneous Cardiovascular Interventions (EAPCI) has analyzed data from 30 member countries. National STEMI and PCI registers have been used as data sources, as well as data on hospitalization and treatment of patients with STEMI and data on PCI and pPCI procedures in each country. For most countries these cover the period of 2007- 2008. The annual number of patients hospitalized for acute myocardial infarction (AMI) in these 30 countries rates between 90 and 312 in 100,000 citizens. Out of that number, there are 44 to 142/100,000 STEMI patients. PPCI is dominantly used in 16 countries, whereas TL is the prevailing therapy in 8 countries (5 countries had data only for pPCI). The percentage of pPCI usage is between 5 and 90% (for all STEMI patients), whereas for TL it is between 0 and 55% (in Serbia, 19% of patients are treated with pPCI, 33% with TL, and as many as 48% of patients receive conservative treatment). The annual number of pPCI procedures in 100,000 citizens is between 2 and 97. The average number of citizens per one pPCI centre varies between 0.3 and 7.4 million. Intrahospital mortality of STEMI patients is between 4.2 and 13.5% (for patients treated with pPCI it is 2.7-8%, whereas for patients treated with TL it is 3.5-14%). In European countries the time measured from the onset of pain until first medical contact is 60 to 210 minutes, and from PMK to the balloon it is 60 to 177 minutes (in Serbia, the interval from pain onset to the balloon is about 240 minutes). Approximately half of the patients with AMI are transported by emergency medical service (EMS). Conclusion: When comparing Serbia to other European countries, we can conclude that reperfusion therapy as the only optimal treatment for patients with STEMI is not used frequently enough. Also, the interval from PMK to the balloon is considerably longer than the optimal 60 minutes.