Sedmogodišnji trendovi u rezultatima hrvatske mreže primarne perkutane koronarne intervencije

The authors investigated trends in the Croatian primary Percutaneous Coronary Intervention (pPCI) Network results among three consecutive time intervals (2005-2007, first phase; 2008-2009, second phase; and 2010-2011, third phase). Data on 5650 patients with acute myocardial infarction with ST-elevation (STEMI ) transferred or directly admitted and treated with pPCI in 11 Croatian PCI centers during the study period were collected and analyzed. The number of patients with acute STEMI treated with pPCI per year rose continuously during the study period (581 vs.1272 vs. 1949 patients/year). The patient risk profile worsened during the study period: age (60 vs. 61 vs. 63 years; p<0.01), anterior myocardial wall involvement (43% vs. 44% vs. 51%; p<0.01), shock rate (7% vs. 9% vs. 11%; p<0.05), and percentage of transferred patients (42% vs. 36% vs. 46%; p<0.01). While the door-to-balloon time shortened (108 vs. 98 vs. 75 min; p<0.01), the symptom onset-to-door time increased (130 vs. 175 vs. 195 min; p<0.01), but without statistically significant influence on the total ischemic time. Multivariate log-linear analysis eliminated influence of a higher risk profile on the results of treatment and yielded no statistically significant changes in final TIMI 3 flow (Thrombolysis In Myocardial Infarction 3), in-hospital mortality, and six-month mortality rate, but revealed a significant increase in the rate of angina pectoris (12 vs. 22 vs. 36%; p<0.01) and other major adverse cardiovascular events (MACE; 6 vs. 23 vs. 14%; p<0.01) during follow up. In conclusion, the Croatian pPCI Network continuously ensures very good results of STEMI treatment in this economically less developed European country despite worsening of the risk profile in treated patients and opening of new, less experienced PCI centers. The higher percentage of MACE over time could be explained by changes in the pPCI strategy introduced over time (the culprit lesion only) and higher availability of PCI centers for additional PCI after acute STEMI. However, there is room for improvement, especially in reducing prehospital delay.Autori su istražili trendove u rezultatima Hrvatske mreže primarne perkutane koronarne intervencije (primary percutaneous coronary intervention, pPCI) između tri razdoblja (2005.-2007. (prva faza), 2008.-2009. (druga faza), 2010.-2011. (treća faza)). Prikupljeni su i izračunati podaci o 5650 bolesnika s akutnim infarktom sa ST-elevacijom (STEMI ) transportiranih ili izravno zaprimljenih i liječenih pomoću pPCI u 11 hrvatskih PCI centara tijekom toga vremena. Godišnji broj bolesnika s akutnim STEMI liječenih pomoću pPCI kontinuirano je rastao tijekom istraživanog vremena (581 prema 1272 prema 1949 bolesnika/godina). Rizični profil bolesnika se pogoršao kroz istraživano vrijeme: dob (60 prema 61 prema 63 godine; p<0,01), zahvaćanje prednje miokardijalne stijenke (43% prema 44% prema 51%; p<0,01), udio šoka (7% prema 9% prema 11%; p<0,05), postotak transportiranih bolesnika (42% prema 36% prema 46%; p<0,01). Dok se vrijeme od dolaska u bolnicu do uvođenja balona skraćivalo (108 prema 98 prema 75 min; p<0,01), vrijeme od nastupa simptoma do dolaska u bolnicu se produžavalo (130 prema 175 prema 195 min; p<0,01), ali bez statistički značajnog utjecaja na ukupno vrijeme ishemije. Multivarijatna log-linearna analiza, eliminirajući utjecaj višeg rizičnog profila na rezultate liječenja, nije pronašla statistički značajne promjene u završnom protoku TIMI 3 (Thrombolysis In Myocardial Infarction 3), bolničkom pobolu i smrtnosti tijekom šest mjeseci, ali je pokazala značajan porast učestalosti pektoralne angine (12% prema 22% prema 36%; p<0,01) i drugih velikih nepovoljnih kardiovaskularnih događaja (major adverse cardiovascular events, MACE) (6% prema 23% prema 14%; p