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.

Ain Shams University Cairo Egypt

ANMCO Research Center Heart Care Foundation Florence Italy

Cardiac Rehabilitation Research Center Cardiovascular Research Institute Isfahan University of Medical Sciences Isfahan Iran

Cardiocenter 3rd Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady Prague Czech Republic

Cardiocentre Presov Teaching Hospital of J A Reiman Presov Slovakia

Cardiology 1 and Cardiology 2 University Hospital Center Mother Theresa Tirana Albania

Centre of Cardiology North Estonia Medical Centre Tallinn Estonia

Centro Hospitalar e Universitário do Algarve Faro Portugal

Chapidze Emergency Cardiology Center Tbilisi Georgia

Department of Cardiac Sciences King Fahad Cardiac Center College of Medicine King Saud University Riyadh Saudi Arabia

Department of Cardiology Aalborg University Hospital Aalborg Denmark

Department of Cardiology Clinical Center of Serbia Belgrade Serbia

Department of Cardiology Leeds Institute for Cardiovascular and Metabolic Medicine University of Leeds Leeds Teaching Hospitals NHS Trust Leeds UK

Department of Cardiology University of Tartu Tartu Estonia

Department of Internal Medicine and Cardiology Medical Faculty of Masaryk University University Hospital Brno Brno Czech Republic

Department of Interventional Cardiology Institute of Cardiology Jagiellonian University Medical College John Paul 2 Hospital Krakow Poland

EURObservational Research Programme European Society of Cardiology Sophia Antipolis France

Faculty of Medicine University of Belgrade Belgrade Serbia

Heart and Lung Center Helsinki University Hospital and Helsinki University Helsinki Finland

Heart and Vascular Center Semmelweis University Budapest Hungary

Hôpital Européen Georges Pompidou Service de Cardiologie Paris Paris France

Hospital Rudolfstiftung Vienna Austria

Institute of Cardiovascular Sciences University of Birmingham Birmingham UK

Interventional Cardiology Unit Annunziata Civil Hospital Cosenza Italy

Iraqi Board for Medical Specializations Scientific Council of Cardiology Baghdad Heart Centre Medical City Baghdad Iraq

Klinikum der Stadt Ludwigshafen and Institut für Herzinfarktforschung Ludwigshafen am Rhein Germany

Kyrgyz State Medical Academy Bishkek Kyrgyzstan

Mater Dei Hospital Msida Malta

Medical Faculty University of Prishtina 'Hasan Prishtina' University Clinical Centre of Kosova Prishtina Kosovo

National and Kapodistrian University of Athens Attikon University Hospital Athens Greece

National Center of Cardiology and Internal Medicine Bishkek Kyrgyzstan

Rabin Medical Center Petah Tikva Israel

Scientific Research Institute of Cardiology named after Levon Hovhannisyan Yerevan Armenia

Spitalul Clinic de Urgenta 'Floreasca' Bucharest Romania

St Vincent's University Hospital Dublin 4 Ireland

Vilnius University Faculty of Medicine Vilnius Lithuania

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