Coronary Care Unit, Cardiovascular Department, Sestre Milosrdnice University Hospital, Zagreb, Croatia.
Am J Cardiol. 2010 May 1;105(9):1261-7. doi: 10.1016/j.amjcard.2009.12.041. Epub 2010 Mar 11.
The Republic of Croatia, with a gross domestic product per capita of US$11,554 in 2008, is an economically less-developed Western country. The goal of the present investigation was to prove that a well-organized primary percutaneous coronary intervention network in an economically less-developed country equalizes the prospects of all patients with acute ST-segment elevation myocardial infarction at a level comparable to that of more economically developed countries. We prospectively investigated 1,190 patients with acute ST-segment elevation myocardial infarction treated with primary PCI in 8 centers across Croatia (677 nontransferred and 513 transferred). The postprocedural Thrombolysis In Myocardial Infarction flow, in-hospital mortality, and incidence of major adverse cardiovascular events (ie, mortality, pectoral angina, restenosis, reinfarction, coronary artery bypass graft, and cerebrovascular accident rate) during 6 months of follow-up were compared between the nontransferred and transferred subgroups and in the subgroups of older patients, women, and those with cardiogenic shock. In all investigated patients, the average door-to-balloon time was 108 minutes, and the total ischemic time was 265 minutes. Postprocedural Thrombolysis In Myocardial Infarction 3 flow was established in 87.1% of the patients, and the in-hospital mortality rate was 4.4%. No statistically significant difference was found in the results of treatment between the transferred and nontransferred patients overall or in the subgroups of patients >75 years, women, and those with cardiogenic shock. In conclusion, the Croatian Primary Percutaneous Coronary Intervention Network has ensured treatment results of acute ST-segment elevation myocardial infarction comparable to those of randomized studies and registries of more economically developed countries.
克罗地亚共和国 2008 年人均国内生产总值为 11554 美元，是一个经济欠发达国家。本研究的目的是证明在经济欠发达国家建立一个组织良好的经皮冠状动脉介入治疗网络，可以使所有急性 ST 段抬高型心肌梗死患者的前景与更发达的经济国家相当。我们前瞻性地调查了克罗地亚 8 个中心的 1190 例接受直接经皮冠状动脉介入治疗的急性 ST 段抬高型心肌梗死患者（677 例未经转运和 513 例转运）。比较了非转运亚组和转运亚组、老年患者亚组、女性患者亚组和心源性休克患者亚组的经皮冠状动脉介入治疗后血栓溶解心肌梗死血流、住院死亡率和 6 个月随访期间主要不良心血管事件（即死亡率、胸痛、再狭窄、再梗死、冠状动脉旁路移植术和脑血管意外发生率）的发生率。在所有接受调查的患者中，平均门球时间为 108 分钟，总缺血时间为 265 分钟。87.1%的患者术后血栓溶解心肌梗死血流 3 级，住院死亡率为 4.4%。在所有患者中，转运组和非转运组之间，以及>75 岁患者、女性患者和心源性休克患者亚组之间，治疗结果均无统计学差异。总之，克罗地亚直接经皮冠状动脉介入治疗网络确保了急性 ST 段抬高型心肌梗死的治疗效果与更发达经济国家的随机研究和登记结果相当。
