Acute Coronary Syndrome in Croatia.

Abstract

SAŽETAK: Hrvatska u području liječenja akutnoga koronarnog sindroma metodama intervencijske kardiologije (perkutane koronarne intervencije, PCI) vrlo usko prati svjetske rezultate unatoč relativno niskim ulaganjima u zdravstveni sustav u usporedbi s razvijenim zemljama. U posljednjih desetak godina, otkada postoji Hrvatska mreža primarne PCI, hitno je liječeno nešto više od 15 000 bolesnika s akutnim infarktom miokarda s elevacijom ST segmenta (STEMI), a, prema istom principu, liječe se i drugi bolesnici s nestabilnim akutnim koronarnim sindromom. U posljednjim godinama mreža zbrinjava oko 540 -550 bolesnika s akutnim STEMI-jem na milijun stanovnika, a svaki od jedanaest PCI centara koji rade na principu 24/7 zbrinjava prosječno nešto više od 384 000 stanovnika. Prema trendovima zadnjih deset godina, jasan je porast rizičnoga profila tih bolesnika uz održavanje rezultata liječenja na razinama komparabilnima s onima sličnima PCI mrežama (postproceduralni TIMI III protok do 91 %, unutarbolnički mortalitet od 4,4 do 6,3%). Budući su planovi razvijanje kontinuiranoga prospektivnog elektroničkog Registra invazivne i intervencijske kardiologije te akutnoga koronarnog sindroma, daljnje skraćivanje reperfuzijskih vremena, daljnje povećanje uvođenja optimalnih lijekova i materijala u liječenje ovakvih bolesnika te optimizacija liječenja i akutnog infarkta miokarda bez elevacije ST segmenta na cijelom području Republike Hrvatske. SUMMARY:In the field of acute coronary syndrome management by the methods of interventional cardiology (percutaneous coronary intervention, PCI), Croatian medicine has closely followed international results in spite of the relatively low investments in the Croatian healthcare system as compared with industrialized countries. Since the establishment of the Croatian Primary Percutaneous Coronary Intervention Network, i.e. in the last decade, more than 15,000 patients with acute myocardial infarction with ST-segment elevation (STEMI) were treated with PCI; the same treatment protocol has also been applied in other patients with unstable acute coronary syndrome. In recent years, the network has managed 540-550 patients with acute STEMI per million inhabitants, with each of the eleven PCI centers providing care for more than 384,000 catchment population through 24/7 work schedule. The trends observed in the past decade show the risk profile of these patients to increase, while maintaining the results of treatment at the levels comparable to those reported from similar PCI networks (postprocedural TIMI III flow up to 91% and in-hospital mortality ranging from 4.4% to 6.3%). Future plans include development of a continuous prospective electronic Registry of Invasive and Interventional Cardiology and Acute Coronary Syndrome, further reduction of reperfusion time, increasing introduction of optimal medication and materials in the treatment of these patients, and optimization of treatment of acute myocardial infarction without ST-segment elevation all over Croatia.

Importance of Acute Cardiac Care Registries at the National Level

“…According to this and other investigations 15 , there is a respectable access to tertiary hospitals for urgent cardiac patients in Croatia. tertiary hospitals are distributed across all Croatian regions and coupled with the nearest regional and county hospitals in the organizational network.…”

“…each of the eleven PCI centers in Croatia with 24/7 work schedule had a catchment population of 384,000 inhabitants, approaching the number of at least 600 primary PCIs per million inhabitants. On the contrary, we found that only 380-390 non-St-segment elevation myocardial infarction (nStemI) patients per million inhabitants received PCI in the first 72 hours 15 . Croatia has achieved a decreasing mortality trend in coronary heart disease, as well as in the overall cardiovascular pathology in the past ten years (53% vs. 47%).…”