V roku 2011 na Slovensku bol nepretržitý 24/7 program primárnej PKI (P-PKI) u STEMI vykonávaný v štyroch PKI centrách. Vychádzajúc z geografického rozloženie P-PKI centier a počtu obyvateľov pripadajúcich na jedno P-PKI centrum (1,37 mil. obyv./P-PKI centrum) v danom období bolo možné hodnotiť dostupnosť P-PKI ako suboptimálnu. Cieľom analýzy je vyhodnotenie 2-ročného prežívania pacientov so STEMI prijatých do nemocníc v roku 2011 a posúdenia prežívania vo vzťahu k použitej liečebnej stratégii. Pre analýzu klinických údajov bola použitá databáza SLOVenského registra Akútnych Koronárnych Syndrómov. V tejto analýze sme vyhodnotili 1 580 prípadov AKS (STEMI, NAP a non-STEMI). Zo všetkých STEMI 80,6 % pacientov bolo hospitalizovaných v P-PKI centrách, a to buď formou primárneho, alebo sekundárneho transportu. Primárna reperfúzna liečba bola vykonaná u 76 % pacientov (64,7 % P-PKI, 11,3 % fibrinolýza). 82,3 % pacientov so STEMI bolo prijatých do 12 hodín od vzniku príznakov. Medián celkového ischemického času bol 219 min. V analyzovanej kohorte pacientov so STEMI bola nemocničná mortalita 5,99 %, 30-dňová mortalita 10,7 %, ročná mortalita 14,6 % a dvojročná mortalita 17,6 %. Dvojročné prežívanie pacientov liečených P-PKI bolo signifikantne lepšie oproti pacientom bez primárnej reperfúznej liečby (HR 0,4, p < 0,001) a porovnateľné s pacientami liečenými fibrinolýzou (p = 0,66). 90,7 % pacientov liečených fibrinolýzou však následne absolvovali koronarografické vyšetrenie a podľa potreby rescue, či odloženú PKI. Farmakoinvazívna stratégia reprezentovala podskupinu s najlepšou prognózou, avšak benefit oproti pacientom s P-PKI nedosiahol štatistickú významnosť (p = 0,164). V skupine zomretých pacientov liečených P-PKI medián celkového ischemického času (interval príznaky–PKI) bol 300,5 min, kým u pacientov liečených P-PKI, avšak prežívajúcich dva roky bol 230,5 min (p = 0,043). Signifikantne horšie dvojročné prežívanie mali diabetici (HR 1,63, 95%, p = 0,03).

Four 24/7 P-PCI centres performed emergency program in 2011 in Slovakia. In view of the geographic relations and number of residents per centre (1.37 mil. residents/centre) it was possible to consider access to P-PCI as sub-optimal. The aim of the study is an evaluation of two-year survival of STEMI cohort admitted to hospitals in 2011 and confrontation of survival with used treatment strategy. Clinical outputs were analysed using data acquired from the SLOVak registry of Acute Coronary Syndromes (SLOVAKS). In this analysis we have evaluated 1 580 cases of ACS (STEMI, UAP and NSTEMI). 80.6% of STEMI patients have been admitted into P-PCI-centres via primary or secondary transfer. Primary reperfusion treatment was accomplished in 76.0% of patients (64.7% primary PCI, 11.3% fibrinolysis). 82.3% STEMI patients were admitted within 12 h of symptoms onset. The median of total ischemic time was 219 minutes. In the analysed cohort of STEMI patients an in-hospital mortality of 5.99% was recorded, a 30-day mortality of 10.7%, a one-year mortality of 14.6% and a two-year mortality of 17.6%. The two-year survival of patients treated with P-PCI was significantly better compared with patients without primary reperfusion treatment (HR 0.4, p < 0.001) and comparable with patients treated by thrombolysis (p = 0.66). A total of 90.7% of patients after thrombolysis, however, subsequently underwent coronary angiography and as needed a rescue or delayed PCI was performed. Pharmacoinvasive strategy represented the sub-group with the best prognosis, even though the benefit versus the sub-group treated with primary PCI did not achieve statistical significance (p = 0.164). In patients with P-PCI who died, the median of the total ischemic time (the symptoms–PCI interval) was 300.5 min, while in the patients who survived to two years the median was 230.5 min (p = 0.043). Significantly worse two-year survival was observed in diabetics (HR 1.63, 95% CI, p = 0.03). Conclusions: In 2011 it was possible to record a continuation of the favourable trend in the management of patients with STEMI in Slovakia. The greatest challenge for health care workers in the coming years will be to ensure primary reperfusion treatment for patients in the desired time intervals. Our analysis confirms the excellent prognosis of patients managed through a pharmacoinvasive strategy. The mid-term survival of patients after ACS in Slovakia points to worse results in comparison with results from abroad, which could be associated with an unfavourable length of total ischemic time and less consistent secondary prevention could be speculated.

5 Internal Clinic of University Hospital in Bratislava Slovak Republic

Cardiocentre in Nitra Slovak Republic

Cardiocentre of Faculty Hospital J A Reiman in Prešov Slovak Republic

Cardiocentre of MFN in Martin Slovak Republic

Cardiological Clinic of National Institute of CV Diseases in Bratislava Slovak Republic

Slovak Society of Cardiology Slovak Republic

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