NASSER INSTITUTE FOR TREATMENT AND RESEARCH CAIRO, EGYPT.
Atef Saleh has completed his PhD at the age of 25 years from Ain University and postdoctoral studies from the same University School of Medicine. He is now working as cardiology specialist at Nasser institute for treatment and research at north Cairo and active member in the cardiology department.
Coronary artery disease is most frequent cause of death. Over seven million people every year die from ischemic heart disease. The management of patients with ST-Elevation myocardial infarction is influenced by health care service organizations. Regional STEMI networks for acute myocardial infarction facilitate primary percutaneous coronary intervention (PPCI) and its efficacy in reducing mortality and improving outcomes. The aim of the present study was to assess the feasibility of establishment of regional STEMI network in north Cairo governorate, Egypt and to assess the impact of this network on the practice of hospitals in the network and on patients' outcomes.
Results: The number of patients upon implementation of STEMI network increased from 140 to 212 (51.4%) to the same hospitals with the same facilities and in equal periods of time (6 months). It was found that the mean time of chest pain to first medical contact between the two groups before and after establishment of STEMI network did not change, it was 4 hours in both groups (P=0.36) while the mean door to balloon time improved from 54.3 to 44.1 minutes (P=0.01). In our study thrombolytic therapy use declined from 36.4% before STEMI network set up to only 7.5% (P>0.001), Ejection fraction improved from 51.3% to 55.4% (P>0.001), mitral regurge (MR) also improved upon establishment of STEMI network from 53.6% to 78.8 with (P>0.001), the mean CCU stay in group II was 2 days versus 3 days before implementation of STEMI network (P>0.001), the mean door in door out from the spokes was 40 minutes. In-hospital mortality improved upon establishment of STEMI network from 6.4% to 2.8% (P=0.10).
Conclusions: Establishment of the STEMI network in Egypt is feasible and can lead to improvement of patients' outcomes. Thrombolytic therapy was no longer the main reperfusion therapy and primary PCI was offered to most patients after establishment of STEMI network.