[Treatment of acute ST elevation myocardial infarction with primary percutaneous coronary intervention in Department of Cardiology, Clinical Centre of Serbia, Belgrade: movement and treatment of patients from the onset of chest pain till the attempt of reopening the infarct-related artery].

INTRODUCTION: Treatment of patients with acute ST elevation myocardial infarction starts after the onset of chest pain, involves contacts with medical services, aimed at attempting to recanalize the infarct-related artery with primary percutaneous coronary intervention. True ischaemic time correlates with the extent of myocardial necrosis, and it is essential to reduce every unnecessary time loss. It has been proven that antiaggregational therapy has an important effect on reopening of the infarct-related artery, function of microcirculation and prevention of stent thrombosis.
OBJECTIVE: The aim of this study was to determine movement and treatment of patients, from the onset of symptoms till leaving the catheterization laboratory, and, if necessary, to propose corrections according to medical guidelines and medicolegal obligations.
METHOD: This study presents a part of a larger project, designed in three phases. Here are presented the first two completed phases. The first phase enrolled the total of 228 patients, with retrospective acquisition of data from the medical documentation. In the second phase, the total of 277 patients were enrolled, and data were collected with special graphico-textual form upon the patient's arrival to the catheterization lab. Data were checked with the First-Aid Station of Belgrade and the Department of Emergency Cardiology of our Clinic. In the third phase, it has been planned to improve the graphico-textual form and to distribute it to all institutions involved in treatment of these patients.
RESULTS: The patients mainly moved centrifugally--from the catheterization lab (in this manner, 95% of patients were transferred by the first-aid station, and 31% patients were sent from other hospitals), instead of centripetally--towards the catheterization lab. The median time of reaction of the First-Aid Station of Belgrade was 15 minutes. The median of true ischaemic time was 260 minutes; the median time from the onset of chest pain to diagnostic ECG was 60 minutes, while the median time from diagnostic EKG to the first balloon inflation was 177 minutes. Upon arrival to the catheterization lab, a median of 18 minutes passed till the insertion of the catheter, and the median procedure duration was 35 minutes. Dual antiaggregational therapy was administered relatively late on the way to the catheterization lab (the first-aid station missed the opportunity to administer clopidogrel in 84% of patients, aspirin in 86%, other hospitals did not administer clopidogrel in 40% and aspirin in 41% of patients).
CONCLUSION: Optimal medical data acquisition is essential for the quality assessment of health services. Our data indicate that in logistics and organization of treatment of patients with acute ST elevation myocardial infarction, further improvements could be made in order to implement official guidelines and medicolegal obligations. The third phase of this project is necessary to achieve these objectives.