Progress seen after the first year of "stent for life" Initiative in Portugal

Abstract

Purpose: The Stent for Life (SFL) project's main goal is to improve local ST-elevation myocardial infarction (STEMI) in countries with lower rates of primary percutaneous coronary intervention (PPCI). It was in this setting that the Portuguese Association of Cardiovascular Intervention joined, in February 2011, the SFL Initiative, which helped to define actions to increase the quantity and quality of PPCI performed in Portugal. This study is intended to describe the progress seen after the first year of Portugal inclusion in the SFL Initiative. Methods: The Initial phase of SFL's project in Portugal was focused on public campaigns and to improve prehospital access through the National Institute for Medical Emergency (INEM). To evaluate the progress seen after this first year, a national survey was implemented for a one-month period in two consecutive periods: the first was applied in 2011 at the time of initial integration of SFL Initiative in Portugal (Moment Zero) and the second in 2012 after one year of operation (Moment One). We compared the performance indicators of PPCI between the two consecutive years. Results: Seventeen national Portuguese centres of Interventional Cardiology where PPCI is carried out 24/7 participated in this study: 201 pts on Moment Zero and 196 in Moment One (mean age was 62±13 years, 20% female and 18% were diabetic). Only 33% of the patients used the single national number for medical emergencies (112) to call for support in Moment Zero, but there was a slight increase of 5% in absolute value after one year of SFL's intervention. There was a significant reduction in patients which the first medical contact was a non-PPCI hospital (62% vs 47%, p=0.004) and an increased in direct transfer from INEM service to a PPCI centre (13% vs 37%, p <0.001). The main improvement was a significant reduction in patient delay (118 min in Moment Zero vs 102 min in Moment One, p=0.008). The door-to-balloon (55 min vs 53 min) and the treatment delay (262 min vs 250 min) remained constant. Conclusions: After the first year of SFL Initiative in Portugal, there was an improvement of the performance indicators of primary PCI, mainly in patient-delay. This reflects the success of the action plan's first year focused on raising public awareness. In the next year, the new target of national SFL Initiative will be the improvement of system-delay.