Aims  The aim of this study was to determine the contemporary use of reperfusion therapy in the European Society of Cardiology (ESC) member and affiliated countries and adherence to ESC clinical practice guidelines in patients with ST-elevation myocardial infarction (STEMI). Methods and results  Prospective cohort (EURObservational Research Programme STEMI Registry) of hospitalized STEMI patients with symptom onset <24 h in 196 centres across 29 countries. A total of 11 462 patients were enrolled, for whom primary percutaneous coronary intervention (PCI) (total cohort frequency: 72.2%, country frequency range 0–100%), fibrinolysis (18.8%; 0–100%), and no reperfusion therapy (9.0%; 0–75%) were performed. Corresponding in-hospital mortality rates from any cause were 3.1%, 4.4%, and 14.1% and overall mortality was 4.4% (country range 2.5–5.9%). Achievement of quality indicators for reperfusion was reported for 92.7% (region range 84.8–97.5%) for the performance of reperfusion therapy of all patients with STEMI <12 h and 54.4% (region range 37.1–70.1%) for timely reperfusion. Conclusions  The use of reperfusion therapy for STEMI in the ESC member and affiliated countries was high. Primary PCI was the most frequently used treatment and associated total in-hospital mortality was below 5%. However, there was geographic variation in the use of primary PCI, which was associated with differences in in-hospital mortality.

BackgroundThe provisional side-branch intervention strategy remains the gold standard approach for repair of coronary bifurcation lesions. We performed this study to evaluate the clinical and functional outcomes of using the instantaneous wave-free ratio (iFR) for physiological assessment in provisional side-branch repair of bifurcation lesions.MethodsFifty patients with coronary bifurcation lesions were equally divided into two groups: (I) an iFR-guided side-branch intervention group and (II) a conventional group, in which the operator selected a different interventional method. After the procedure, we performed a six-month follow-up for postoperative ejection fraction (EF) and clinical cardiac outcomes.ResultsOur results showed that the iFR measurement procedure was technically feasible in bifurcation lesions, with no procedural-related complications. Moreover, measuring iFR significantly predicted the side-branch percent stenosis after stenting of the main branch (r = −0.81, p < 0.0001). Compared to the conventional group, the iFR-guided group showed a significantly shorter procedural time (MD = −14.6 min, 95% CI [−27.7, −1.4]) and hospital stay duration (MD = −0.92 days, 95% CI [−1.6, −0.28]). However, no significant differences were recorded between the iFR-guided and conventional groups in terms of postoperative EF (p = 0.9), six-month heart failure class (p = 0.89), or post-interventional angina (p = 0.066).ConclusionUsing iFR for physiological assessment during the provisional side-branch intervention strategy can reduce the procedural time and length of hospital stay in patients with bifurcation lesions. Larger trials should compare the clinical outcomes of iFR to other physiological assessment methods such as the fractional flow reserve (FFR) in patients with coronary bifurcation lesions.ClinicalTrials.gov number: NCT02785510

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