Kaifoszova Zuzana, Kala Petr, Alexander Thomas, Zhang Yan, Huo Yong, Snyders Adriaan, Delport Rhena, Alcocer-Gamba Marco Antonio, Gavidia Leslie Marisol Lugo
HELIS Partners Consulting, Prague, Czech Republic.
EuroIntervention. 2014 Aug;10 Suppl T:T87-95. doi: 10.4244/EIJV10STA14.
This paper describes the opportunities and challenges in building ST-elevation acute myocardial infarction (STEMI) systems of care in Stent for Life affiliated and collaborating so-called emerging countries, namely India, China, South Africa and Mexico, where CAD mortality is increasing and becoming a significant healthcare problem. The Stent for Life model supports the implementation of ESC STEMI Guidelines in Europe and endeavours to impact on morbidity and mortality by improving services and developing regional STEMI systems of care, whereby STEMI patients' timely access to a primary percutaneous coronary intervention (PPCI) is assured. In India, the STEMI India model incorporates a dual approach of combining PPCI with a pharmacoinvasive strategy of reperfusion. The architecture of the system is based on a hub and spoke model with each unit called a STEMI cluster. The project is driven by a private non-profit organisation. In China, the STEMI PCI programme is led by the Chinese College of Cardiovascular Physicians and supported by the national government. Although primary PCI is performed nationwide, a thrombolytic treatment strategy is still the first option in many rural areas because of logistic considerations. Establishing local STEMI transfer networks and then implementing a pharmacoinvasive strategy of reperfusion are being considered and promoted currently. In South Africa, the pharmacoinvasive approach currently dominates as STEMI treatment option in many areas. A pilot study shows that low symptom awareness leads to long patient delays. The education of all role players, from patients to healthcare professionals and including institutions and governmental structures, is needed to achieve prompt diagnosis and treatment. In Mexico, improving the treatment of STEMI requires considering myocardial infarction to be an emergency that must be treated by an entire system and not just by a particular service. Patients need to receive quick treatment from clinical and interventional cardiologists, and the emergency medical system (EMS) must understand the importance of early reperfusion therapy when appropriate. Mexican health authorities have used registries as their main strategy for improving the use of health resources for ACS patients. In general, building regional STEMI systems of care and an EMS system infrastructure are critical success factors in the stepwise development of STEMI systems of care at a national level in emerging countries as they are in Europe. An in-depth understanding of healthcare system-level barriers to timely and appropriate reperfusion therapy facilitates the development of more effective strategies for improving the quality of STEMI care in each region and country.
本文描述了在“生命支架”附属及合作的所谓新兴国家（即印度、中国、南非和墨西哥）建立ST段抬高型急性心肌梗死（STEMI）护理系统的机遇与挑战，在这些国家，冠心病死亡率不断上升，已成为一个重大的医疗问题。“生命支架”模式支持在欧洲实施欧洲心脏病学会（ESC）的STEMI指南，并致力于通过改善服务和发展区域STEMI护理系统来影响发病率和死亡率，从而确保STEMI患者能够及时接受直接经皮冠状动脉介入治疗（PPCI）。在印度，“印度STEMI”模式采用了将PPCI与药物侵入性再灌注策略相结合的双重方法。该系统的架构基于中心辐射模式，每个单元称为一个STEMI集群。该项目由一家私人非营利组织推动。在中国，STEMI PCI项目由中国心血管内科医师学会牵头，并得到国家政府的支持。尽管全国都在开展直接PCI，但由于后勤方面的考虑，在许多农村地区溶栓治疗策略仍是首选。目前正在考虑并推广建立当地的STEMI转运网络，然后实施药物侵入性再灌注策略。在南非，药物侵入性方法目前在许多地区是STEMI治疗的主要选择。一项试点研究表明，症状知晓率低导致患者延误时间长。需要对从患者到医疗保健专业人员，包括机构和政府机构等所有相关方进行教育，以实现及时诊断和治疗。在墨西哥，如果要改善STEMI的治疗，就需要将心肌梗死视为一种必须由整个系统而非仅仅由某一特定服务进行治疗的紧急情况。患者需要从临床心脏病专家和介入心脏病专家那里获得快速治疗，并且紧急医疗系统（EMS）必须了解在适当的时候进行早期再灌注治疗的重要性。墨西哥卫生当局将登记作为改善ACS患者医疗资源利用的主要策略。总体而言，与在欧洲一样，建立区域STEMI护理系统和EMS系统基础设施是新兴国家在国家层面逐步发展STEMI护理系统的关键成功因素。深入了解医疗系统层面阻碍及时、适当再灌注治疗的因素，有助于制定更有效的策略，以提高每个地区和国家的STEMI护理质量。
