4ο Πεπιθεπειακό ςνέδπιο Βοπειοαναηολικού Αιγαίος 2ο ςνέδπιο Καπδιαγγειακών Παθήζεων «Ημέπερ Καλύμνος» 8-9 Ιοςνίος 2012, Κάλςμνορ «Πρωτογενής Αγγειοπλαστική (Primary PCI) στον Ελληνικό χώρο» Ι. Κανακάκηρ Διεςθςνηήρ Καπδιολογίαρ Θεπαπεςηική Κλινική Πανεπιζηημίος Αθηνών ΓΝΑ «Αλεξάνδπα»
Reperfusion in AMI : Background
Keely et al. Lancet 2003.
Keely et al. Lancet 2003.
Long-term clinical outcome in the DANAMI-2 study Nielsen P H et al. Circulation 2010;121:1484-1491
Ενδείξειρ Ππωηογενούρ Αγγειοπλαζηικήρ
Delays in Patients Transferred for PCI Μiedema M et al. Circulation 2011;124:1636-1644.
Reperfusion Therapies Differ in Countries 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 7 1 14 12 17 13 10 15 15 20 21 0 25 26 26 7 30 2 12 36 40 39 35 37 5 15 44 42 3 31 52 48 50 50 8 10 63 40 15 15 35 55 92 28 35 86 26 30 81 81 44 75 75 72 70 25 33 66 64 59 41 45 49 45 45 29 35 33 30 30 28 24 23 19 19 9 8 5 CZ SLO DE CH NO DK PL HR SE HU BE IL IT FIN AT FR SK ES LAT UK BG PO SRB GR TR RO P-PCI Thrombolysis No reperfusion
For 40% of the Greek population distance to cath lab covered in less than 2 hours Athens Network 10
PATRAS UNIVERCITY HOSPITAL (PUH) 24 hours / 7 days covered Geographical Area Covered by the catheterization laboratory of UH Patras for ppci GH Agrinio 3,5% GH Mesolongi 9% HC K. Achaia 2% UH Patras 62% GH Ag. Andreas 5% HC Nafpaktos 7% GH Aigio 8% GH Pyrgos 3% HC Krestena 0,5%
SFL Registry Preliminary Results
PCI Centers: 2011
Annual hospital admissions for ACS STEMIs/NSTEMIs: 202 / 100.000 / year STEMIs: 108 / 100.000 inhabitants / year
Proportion of Hospitalized Patients with Acute Coronary Syndrome Global Registry of Acute Coronary Events 62 935 patients in 113 hospitals in 14 countries Deutsches Herzzentrum Munich Rechts der Isar 20 000 PCI patients in 2 university clinics during 10 years NSTEMI STEMI SAP/uSAP Fox et al., JAMA 2007 Ndrepepa et al., Cardiology 2009
PCI Procedures 2007-2010 25000 20000 15000 20111 19566 19974 16778 2007 2008 2009 2010 10000 5000 10788 10452 10860 9122 6929 6429 5776 4852 2394 2685 3338 2804 0 Total Athens Metro Thess/niki Metro Rest of Greece
Primary PCI numbers: 2007-2011 4000 3500 3000 2500 2000 1500 1000 500 0 1491 1087 1723 1267 2056 1577 2611 2081 3733 3096 249 235 230 252 309 155 221 249 278 328 2007 2008 2009 2010 2011 Greece Athens Metro Thess/niki Metro Rest of Greece
Primary PCI numbers in Greece 95 ppci / million / year in 2009 346 ppci / million / year in 2011
Reperfusion Therapies in Greece Thrombolysis pts Rescue PCI 7,40% Pharmacoinvasive 6,40%
Primary PCI Athens area
STEMI In hospital mortality 12 10 11 10 8 6 5,7 4,7 4 2 0 TL p-pci No reperfusion Rescue PCI
STEMI ppci patients Time Delays Thrombolysis Symptoms FMC FMC needle ppci Symptoms FMC FMC PCI center Door Balloon FMC Balloon 136,91 min 62,17 min 142,41 min 129,11 min 53,41 min 182,52 min
Ratio Total PCI/Primary PCI: 2007-2011 25000 Total PCI 20000 19566 19974 Primary PCI 16778 16120 15000 10000 8,8% 10,2% 15,5% 23% 5000 1723 2056 2611 3733 0 2008 2009 2010 2011
37%
PATIENTS RELATED BARRIERS Goal The majority of patients call EMS Action Education & Media campaign Program ACT NOW SAVE LIVES Regions: a) Athens and b) Patras Possible difficulties False calls Lack of capacity
Stent for Life Public Campaign 2011-2013 In those countries/regions where PPCI network is established and functioning key objectives are: Increase disease awareness among public Educate patients and public to recognize AMI symptoms ACT quickly and call emergency ambulance car Educate about PPCI and its life saving indication
How Can We Improve Patient Delay Public Awareness Campaign Save a Life by knowing the signs of a heart attack and acting quickly to call emergency medical services so the best treatment can be received in the fastest possible timeframe
Various Delays Terkelsten CJ, et al. JAMA 2010;304(7):763-771
EMS RELATED BARRIERS Goal EMS call-ems arrival 10-20 min Ambulance equipped with 12 leads ECG Trained paramedics to diagnose AMI Transfer of pts directly to PPCI hospitals By pass Non-PCI hospitals and ICUs Action Possible difficulties Organization of EMS (call to arrival time) Ambulance will be equiped with ECG Education of EMS staff Better coordination with ppci center on duty Financial deficit Cath lab overload with STEMI pts
ΥΜΠΕΡΑΜΑ (Ι) Tα απνηειέζκαηα ηεο Δζληθήο Καηαγξαθήο ηωλ Ο.Σ.Σ. (SFL) είλαη ελδεηθηηθά ηεο πξνόδνπ πνπ επεηεύρζε ζηε ζεξαπεία ηνπ Ο.Δ.Μ. ηα ηειεπηαία ρξόληα ζηε ρώξα καο. Αλεμάξηεηα από ηελ κέρξη ζήκεξα πξόνδν πηζηεύνπκε όηη ε πξωηνβνπιία Stent for Life ηεο Δπξωπαϊθήο Καξδηνινγηθήο Δηαηξείαο πξέπεη λα ζπλερηζζεί κε κεγαιύηεξε ζπκκεηνρή θαη λα επεθηαζεί ζε όιε ηε ρώξα.
ΥΜΠΕΡΑΜΑ (ΙΙ) Μεηά ηελ αξρηθή θάζε ηνπ πξνγξάκκαηνο (αύμεζε ηνπ αξηζκνύ ηωλ PPCI s ωο ζεξαπεία επαλαηκάηωζεο ηωλ STEMI) πξέπεη λα εζηηάζνπκε ζηα πνηνηηθά ραξαθηεξηζηηθά ηνπ πξνγξάκκαηνο Βξάρπλζε ηωλ ρξόλωλ επαλαηκάηωζεο Αλάπηπμε απνηειεζκαηηθώλ ηνπηθώλ δηθηύωλ πξωηνγελνύο αγγεηνπιαζηηθήο Δπέθηαζε θαη ζε άιιεο θξηηηθέο θαηαζηάζεηο ηωλ Ο.Σ.Σ. όπωο: Ο.Δ.Μ. κε θαηάζπαζε ηνπ ST-δηαζηήκαηνο θαη ζπλερηδόκελε ηζραηκία θαη Ο.Δ.Μ. κε νμεία θαξδηαθή αλεπάξθεηα Γηεπθόιπλζε ζηελ εθαξκνγή λέωλ ηερλνινγηώλ θαη θαξκάθωλ πνπ απνδεδεηγκέλα βειηηώλνπλ ηελ έθβαζε ηωλ αζζελώλ κε Ο.Δ.Μ.