Optimization of Treatment of Acute ST-elevation Myocardial Infarction in Austria: Status 2007

An acute reperfusion of the infarctrelated artery in patients with acute myocardial infarction (MI) efficiently reduces early and late mortality as well as the clinical consequences of MI, i.e. heart failure or death due to malignant arrhythmias. Accordingly, the Austrian Society of Cardiology (OKG) and the Ministry of Health and Women (BMGF) have organized the project, "Flachendeckende Optimierung der Infarkttherapie in Osterreich" and the public information campaign, "Schach dem Herztod" (to shorten patient delay times) which have led to the following recommendations based on the existing guidelines: Time between onset of pain and response to the emergency call should be as short as possible and should last at maximum 15 minutes. For an emergency due to acute chest pain call 144 nationwide in Austria. The respective ambulance/ emergency physician system must reach the next hospital with open catheter facilities to ascertain primary percutaneous coronary intervention (PPCI) within 90 minutes of first medical contact. If PPCI cannot be offered within the recommended time pre-hospital (ambulance) or in-hospital (noncatheter hospital) thrombolysis should be initiated as soon as possible. After thrombolytic therapy transfer of the patient into an open catheter hospital would be preferable to enable performance of rescue-PCI without further time delay in non-responders to thrombolytic therapy. In the hospital with catheter facilities, in-hospital delays (e.g. no direct transfer to the CCU and/or catheter laboratory) have to be avoided. Acute PCI options have to be organized for 24 hours/7 days. Based on recent international and national registry data, a reduction of in-hospital and long-term mortality of about 50 % and more (from an average of 16 % to < 8 %) seems to be realistic. For certain subgroups of patients (e.g. younger patients with anterior wall infarction of less than 2-3 hours duration treated by the fastest available reperfusion strategy), a very low mortality of < 2 % can be expected, which represents top results when compared with international data.