LESSONS FOR THE NATIONAL PPCI NETWORK CROATIA CROATIAN CARDIAC SOCIETY
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1 LESSONS FOR THE NATIONAL PPCI NETWORK CROATIA CROATIAN CARDIAC SOCIETY Assist. Prof. Zdravko Babic, M.D.,Ph.D. Working Group for Acute Coronary Syndrome Croatian Cardiac Society Dubrovnik Highlights 2013
2 Prof. Vjeran Nikolic Heitzler, M.D., Ph.D., 1 Academician Davor Milicic, M.D., Ph.D., 2 Prof. Hrvoje Pintaric, M.D., Ph.D., 1 Assist. Prof. Boris Starcevic, M.D., Ph.D., 3 Assist.Prof. Maja Strozzi,M.D.,Ph.D., Prof. Alexander Ernst, M.D.,Ph.D., 2 Vjekoslav Tomulic,M.D.,Zeljko Plazonic, 4 Lovel Giunio, M.D., Assist. Prof. Ivo Vukovic, M.D., Ph.D., 5 Assist. Prof. Robert Steiner, M.D., Ph.D., 6 Prof. Robert Bernat, M.D.,Ph.D., 7 Jozica Sikic, M.D., Ph.D. 8, Assist.Prof. Albino Jović,M.D.,Ph.D., 9 Deiti Prvulovic,M.D. 10 Damir Kozmar, M.D University Hospital Sestre milosrdnice, Zagreb, Croatia 2 University Hospital Center Zagreb, Zagreb, Croatia 3 University Hospital Dubrava, Zagreb, Croatia 4 University Hospital Center Rijeka, Rijeka, Croatia 5 University Hospital Center Split, Split, Croatia 6 University Hospital Osijek, Osijek, Croatia 7 Special Hospital for Cardiovascular diseases Magdalena, Krapinske toplice 8 University Hospital Sveti Duh, Zagreb, Croatia 9 General Hospital Zadar, Zadar, Croatia 10 General Hospital Slavonski brod, Slavonski brod, Croatia 11 University Hospital Merkur, Zagreb, Croatia 2
3 CROATIAN CARDIAC SOCIETY FACTS ABOUT CROATIAN ppci NETWORK Started in 2005 Step-by-step implementation Proportional allocation in all parts of Croatia Continuous mutual communication 3
4 4
5 TRENDS OF TREATMENT RESULTS IN CROATIAN PPCI NETWORK ( )
6 PATIENTS AND METHODS -retrospective multicentric study -time period: Sep 1st Aug 31st 2007 (first phase),jan 1st Dec 31st 2009 (second phase), Nov 1st Nov 1st 2011 (third phase) -11 PCI centres in all parts of Croatia - UHC Sestre milosrdnice, UHC Zagreb, CH Dubrava, UHC Rijeka, UHC Split, SH Magdalena, CH Sveti duh, UHC Osijek, GH Zadar, GH Slavonski brod, CH Merkur -patients: acute STEMI patients treated with primary PCI; 1161 in first phase, 2543 in second phase and 1946 in third phase of investigation acute NSTEMI patients treated with primary PCI; 401 in second phase and 1177 in third phase -patients were transfered from outside hospitals or directly admitted in PCI centres
7 STEMI
8 RESULTS Croatian PPCI Network No.of STEMI/year STEMI/ year
9 RESULTS Croatian PPCI Network No.of STEMI/year -455 PPCI/million inhibitants/year (2011) - > 90% of population covered with PPCI 24/7 system PPCI/million inhibitants/year (2012)
10 RESULTS Croatian PPCI Network Risk profile - STEMI 70 % Age Female gender Anterior wall Age p<0.01 Anterior wall p<0.01
11 RESULTS Croatian PPCI Network Risk profile- STEMI 1,6 1,4 1,2 1 0,8 0,6 0,4 LM By-pass 0,2 0 CpPCINet CpPCINet CpPCINet 10-11
12 RESULTS Croatian PPCI Network Risk profile - STEMI % 8 7,8 7,6 7,4 7,2 7 6,8 6,6 6,4 6, p<0.01 Cardiogenic shock
13 RESULTS Croatian PPCI Network Risk profile - STEMI 50 % Transfered pts p<0.01
14 RESULTS Croatian PPCI Network STEMI STEMI pts p Symptom onset-to-door (min.) <0.01 Door-to-balloon (min.) <0.01 Symptom onset -to-balloon (min.)
15 RESULTS Croatian PPCI Network STEMI STEMI pts p* p * * Postprocedural TIMI 3 flow (%) , < Mortality (in-hospital) (%) < Mortality (6 month follow-up) Pectoral angina (6 month follow-up) <0.01 <0.01 MACE (other) (6 month follow-up) <0.01 <0.01 * χ2 test ** multivariate log-linear analysis
16 NSTEMI
17 RESULTS Croatian PPCI Network Risk profile - NSTEMI 70 % Age Female gender Transfered pts. Anterior wall Age p<0.01 Transfered pts. p<0.05
18 RESULTS Croatian PPCI Network Risk profile - NSTEMI % Cardiogenic shock
19 RESULTS Croatian PPCI Network NSTEMI NSTEMI pts Pain-to-balloon <2h Pain-to-balloon 2-72h Age (y) Gender (M/F) (%) 64/36 65/35 Myocardial wall (% ant./inf.) 55/45 44/56 Cardiogenic shock (%) Postprocedural TIMI 3 flow (%) Mortality (in-hospital) (%)
20 RESULTS Croatian PPCI Network NSTEMI NSTEMI pts p* Postprocedural TIMI 3 flow (%) Mortality (in-hospital) (%) Mortality (6 month follow-up) Pectoral angina (6 month follow-up) <0.05 MACE (other) (6 month follow-up) <0.01 * χ2 test
21 CARDIOVASCULAR MORTALITY IN CROATIA Other diseases Malignant diseases Year % Other CVD Stroke Coronary artery diseases Malignant diseases Year % Year % Other diseases Other CVD Stroke Coronary artery diseases
22 PROBLEMS OF CROATIAN PPCI NETWORK -training and equipment to identify STEMI on ambulance level -strategies to minimize early cardiac arrest (AED, CPR) -therapeutic hypothermia -funding reduction -symptom onset-to-door time -gray zones without 24/7 service (<10% population)
23 PROBLEMS OF CROATIAN PPCI NETWORK -training and equipment to identify STEMI on ambulance level -strategies to minimize early cardiac arrest (AED, CPR) -therapeutic hypothermia -funding reduction -symptom onset-to-door time -gray zones without 24/7 service (<10% population) Future actions: - funding increase - continuous education of all network participants, - media campaign and education of population about MI and adequate treatment of sudden cardiac death - introduction of continuous register - additional development of PCI centres in gray zones
24 CONCLUSION CROATIAN PRIMARY PCI NETWORK Despite higher risk profile of treated patients, new centers introduction and other problems: -still ensures excellent results of STEMI/NSTEMI treatment -at least one of the reasons for decrease of cardiovascular mortality
25 THANKS! ISLAND RAB, CROATIA
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