Implementation of a Regional STEMI Network in North Cairo (Egypt): Impact on The Management and Outcome of STEMI Patients.

Background: Regional ST-segment-elevation myocardial infarction (STEMI) networks facilitate timely performance of primary percutaneous coronary intervention (PPCI), reduce mortality and improve outcomes. Few data exist on the feasibility and impact of regional STEMI networks in developing countries. Aim of the Work: The aim of this study was to examine the feasibility and impact of establishing a regional STEMI network on the management and outcomes of STEMI patients in north Cairo. Patients and Methods: A prospective observational study conducted on 352 patients presenting in North Cairo with confirmed diagnosis of STEMI within 48 hours of symptoms. Patients were divided into group I (n = 140) before and group II (n = 212) after establishment of the STEMI network. Both groups were compared as regards patients' demographics, presentation, management and short-term outcomes. The north Cairo regional STEMI network was established among four governmental hospitals and the governmental ambulance was used for interhospital transfer. WhatsApp® was used for trans-network team communication. Results: Mean age of the study population was 55.4 ± 11.02 years and 286 (81.3%) were males. Mean time from chest pain to first medical contact did not change between the two groups (240 minutes; P = 0.36) while door to balloon mean time was reduced (from 54.3 to 44.1 minutes: P = 0.01). Use of thrombolytic therapy declined from 51 (36.4%) to 16 (7.5%) (P < 0.001) while primary PCI increased from 59.8% to 77.1% (p < 0.001). Left ventricular ejection fraction improved from 51.3 ± 10.7 to 55.4 ± 9.1 (P < 0.001), the mean time of CCU stay was reduced from a mean of 3.0 to 2.0 days (P < 0.001) and in-hospital mortality improved from 6.4% to 2.8% (P = 0.10). Conclusion: The establishment of the STEMI network in north Cairo was feasible and improved patients' outcomes. Use of primary PCI increased and in-hospital mortality improved from after establishment of STEMI network.

Primary PCI versus pharmacoinvasive strategy for ST elevation myocardial infarction.

BACKGROUND: The rationale for pharmacoinvasive strategy is that many patients have a persistent reduction in flow in the infarct-related artery. The aim of the present study is to assess safety and efficacy of pharmacoinvasive strategy using streptokinase compared to primary PCI and ischemia driven PCI on degree of myocardial salvage and outcomes. METHODS AND RESULTS: Sixty patients with 1st attack of acute STEMI within 12 h were randomized to 4 groups: primary PCI for patients presented to PPCI-capable centers (group I), transfer to PCI if presented to non-PCI capable center (group II), pharmacoinvasive strategy "Streptokinase followed by PCI within 3-24 h" (group III) and fibrinolytic followed by ischemia driven PCI (group IV). The primary endpoint is the infarction size and microvascular obstruction (MVO) measured by cardiac MRI (CMR) 3-5 days post-MI. Pharmacoinvasive strategy led to a significant reduction in infarction size, MVO and major adverse cardiac and cerebrovascular event (MACCE) compared to group IV but minor bleeding was significantly higher compared to other groups. CONCLUSIONS: Pharmacoinvasive strategy resulted in effective reperfusion and smaller infarction size in patients with early STEMI who could not undergo primary PCI within 2 h after the first medical contact. This can provide a wide time window for PCI when the application of primary PCI within the optimal time limit is not possible. However, it was associated with a slightly increased risk of minor bleeding.