Percutaneous coronary intervention (PCI) evolved as the favored reperfusion strategy. Additional advances in PCI techniques and STEMI management further improved clinical outcomes and reduced mortality rates as well. However, further studies on PCI were needed.
Patients were enrolled from a multinational registry of STEMI cases commissioned by European society of cardiology (ESC). A total of 30 to 60 consecutive patients were with STEMI<24 h from symptom onset between 2015 and 2018. Enrollment was variable and ranged from 5 to 1,356 patients per country. Only few patients were enrolled in Northern Europe (n=242) and western Europe (n=270) compared to Eastern Europe (n = 3846), Southern Europe (n= 2613), North Africa (n = 1356), or the Middle East (n = 3135).
Overall, 72% patients were treated with primary PCI, 18% with fibrinolysis and 9% in no reperfusion (country range 0–75%). Compared with the fibrinolytic group (4.4%) and those with no reperfusion (14.1), mortality was the best in patients treated with primary PCI (3.1%). In only 9% of cases (2% in western Europe), reperfusion therapy was withheld despite allowing enrollment of patients up to 24 h. On the other hand, US data from 2003 to 2010 suggested that 34-40.5% of STEMI patients were treated medically with reperfusion therapy more in the Northeast. The reasons for this difference are unknown. However, concerns on selective bias ESC registry were raised.
The reach of primary PCI has spread across the globe. However, it is understood that many patients still do not have timely access to this live-saving intervention.