Aims To use quality indicators to study the management of ST-segment elevation myocardial infarction (STEMI) in different
regions.
Methods
and results
Prospective cohort study of STEMI within 24 h of symptom onset (11 462 patients, 196 centres, 26 European Society of
Cardiology members, and 3 affiliated countries). The median delay between arrival at a percutaneous cardiovascular intervention
(PCI) centre and primary PCI was 40 min (interquartile range 20–74) with 65.8% receiving PCI within guideline recommendation
of 60 min. A third of patients (33.2%) required transfer from their initial hospital to one that could perform
emergency PCI for whom only 27.2% were treated within the quality indicator recommendation of 120 min. Radial access
was used in 56.6% of all primary PCI, but with large geographic variation, from 76.4 to 9.1%. Statins were prescribed at discharge
to 98.7% of patients, with little geographic variation. Of patients with a history of heart failure or a documented left
ventricular ejection fraction ≤40%, 84.0% were discharged on an angiotensin-converting enzyme inhibitor/angiotensin receptor
blocker and 88.7% were discharged on beta-blockers.
Conclusion Care for STEMI shows wide geographic variation in the receipt of timely primary PCI, and is in contrast with the more uniform
delivery of guideline-recommended pharmacotherapies at time of hospital discharge.