Abstract
The success of ST-segment elevation myocardial infarction (STEMI) networks application in Europe and the United States in delivering rapid reperfusion therapy in the community have become an inspiration to other developing countries to develop regional STEMI network in order to improve the STEMI care. Although barriers are found in the beginning phase of constructing the network, recent analysis from national or regional registries worldwide have shown improvement of the STEMI care in many countries over the years. To improve the overall care of patients with STEMI particularly in developing countries, improvements should be focusing on how to minimize the total ischemia time, and this includes care improvement at each step of care after the patient shows signs and symptoms of chest pain. Innovation in health technology to develop the electrocardiogram transmission and communication system, along with routine performance measures of the STEMI network may help bridging the disparities of STEMI system of care between guideline recommended therapy and the real world clinical practice.
Highlights
The success of ST-segment elevation myocardial infarction (STEMI) network introduction in Europe and the United States (US) in increasing the utilization of rapid reperfusion therapy in the community has become an inspiration for many countries to construct a national or regional STEMI network in order to improve the outcome of STEMI patients [1,2,3]
The analysis from 70,093 patients with STEMI admitted to percutaneous coronary intervention (PCI) centers within 12 h of symptom onset and treated with PCI showed that patients who admitted directly to a PCI center were associated with a shorter median total ischemia time and lower propensity-matched 12-month mortality compared with patients who admitted to the PCI center through inter-hospital transfer (228 min versus 270 min, P < 0.001, and 9.6% versus 10.4%, P < 0.001, respectively) [54]
Data from national and regional registries showed that both high-income and low-to-middle income countries have improved their STEMI systems of care
Summary
The success of ST-segment elevation myocardial infarction (STEMI) network introduction in Europe and the United States (US) in increasing the utilization of rapid reperfusion therapy in the community has become an inspiration for many countries to construct a national or regional STEMI network in order to improve the outcome of STEMI patients [1,2,3]. Some barriers are found in the beginning phase of constructing a STEMI network, recent analyses from the national and regional registries that were performed in the highincome and lower-to-middle income countries have shown improvement of care for STEMI patients over the years [4,5,6,7]. Variables that affect early reperfusion therapy in the community including the availability of the health care infrastructures that may varies between each region or country (Table 1) [8], and can be identified by analyzing the data from the on-going national or regional registries as part of the STEMI network program, the so-called performance measures [9]. The results of the analysis are often used as feedback to improve the performance of the STEMI network
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