engleski

Croatian primary PCI Network – first phase results.

INTRODUCTION: Transporting the patients suffering from acute STEMI up to 150 km distance to high volume PCI centers proved to be safe and feasible and superior to standard medical treatment. The total population of Republic of Croatia is 4.437.460 inhabitants (year 2001), with total area of 87.609 sq. km, and gross domestic product per capita of 8.980 US $ (year 2006). Despite the new freeway network, there is still a problem with geographically isolated regions, especially mountains and islands, which may affect the availability of providing health care to the citizens especially in urgent situations. Since the middle of 2005, the Croatian Primary PCI Network (CPPN) was introduced into the system of the Health Institution of the Republic of Croatia using step-by-step and mutual communication principles. The main goal is to achieve equal quality treatment of acute STEMI in all parts of Croatia. MATERIALS AND METHODS: Since the middle of 2005 four high volume PCI centers (in the cities of Zagreb and Rijeka) included in CPPN more than half Croatian citizens. Authors investigated 505 patients with acute STEMI who were treated with primary PCI in those centers, 212 of them were transported from outside regions, while other 293 were from cities of Zagreb and Rijeka. RESULTS: Among all investigated patients 75% were male, average age was 60 years. Among patients citizents of Zagreb and Rijeka average pain-to-door and door-to-balloon times were 117 minutes and 82 minutes respectively, while among transported patients 188 minutes and 155 minutes respectively (p< 0.001 for door-to-balloon time, door means first ER). Differences among values of TIMI flow after primary PCI in both groups were non-significant. Incidence of cardiogenic shock in first group and in transported group was 7% and 5% respectively (p=NS). Higher incidence of malignant ventricular arrhytmias (VT/VF) was found in transported patients (10% vs. 19%, p<0.001). Intrahospital mortality was 4% in patients citizents of Zagreb and Rijeka and 3% in transported patients (p=NS). During 6-months follow-up incidence of angina pectoris was higher in transported patients than in other group (41% vs. 24%, p<0.01), as well as incidences of other MACE (myocardial reinfarction, cerebrovascular insult, target lesion revascularization, death) (14% vs. 11%, p=NS). CONCLUSIONS: The first step of the CPPN implementation ensured the best and equal treatment of acute STEMI for more than half of citizens of Croatia. The goal of the next step is extension of the CPPN to the entire region of Croatia and to shorten transport time. Our results proved possibility of organization of primary PCI network even in developing and geographically unfavorable countries.

STEMI; primary PCI; Network

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