Petr Kala, MD, PhD, Masaryk University and University Hospital Brno, Brno, Czech Republic, shared updates from the Stent for Life Initiative (SFLI; www.stentforlife.com), which aims to improve STEMI treatment in countries with lower rates of primary percutaneous coronary intervention (PPCI), thus reducing patient morbidity and mortality.

Although PPCI is the recommended treatment for patients with STEMI, one study showed that only about 55% of European patients with STEMI were treated with PPCI and that treatment availability varies con siderably among countries [Widimsky P et al. Eur Heart J. 2009].

Consequently, the SFLI was launched in 2008 by the European Association of Percutaneous Cardiovascular Interventions (EAPCI) as part of European Society of Cardiology and EuroPCR. Its objectives include identifying countries or regions with an unmet medical need in the optimal treatment of acute coronary syndrome (ACS) and improving patient access to PPCI. Overall, the program aims to increase the use of PPCI to > 70% among all patients with STEMI and offer around-the-clock service for PPCI procedures at all invasive facilities in the country.

According to Prof Kala, access to PPCI has improved in countries involved in the SFLI since the program was implemented. From 2009 to 2013, for example, access to PPCI in Spain increased from 12.8% to 61.3% coverage [EAPCI, EuroPCR, ESC. SFLI Newsletter, 10th ed. 2014]. Additionally, implementing a PPCI network in Romania in 2010 had a significant impact on STEMI in-hospital mortality [Tatu-Chiţoiu G et al. EuroIntervention. 2012]. The percentage of PPCI in the country increased from 25.0% in 2010 to 49.32% in 2011, and in-hospital mortality decreased from 13.5% to 9.93% from 2009 to 2011. Finally, in 2011, in-hospital mortality was lower in the percutaneous coronary intervention centers than in those without such facilities (7.28% vs 14.20%).

Sharing data from the 6 pilot countries enrolled in the SFLI in 2009, Prof Kala demonstrated considerable improvements in the management of patients with STEMI [EAPCI, EuroPCR, ESC. SFLI Newsletter, 10th ed. 2014]. Between 2007 and 2011, the use of PPCI increased from 23% to 57% in Bulgaria, 33% to 64% in France, 9% to 32% in Greece, 19% to 44% in Serbia, 30% to 50% in Spain, and 8% to 78% in pilot regions of Turkey. This increased use of PPCI was accompanied by a simultaneous decrease in the percentage of patients who did not receive any reperfusion therapy (Figure 1).

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Figure 1.

Trends in Management of Patients With STEMI From 2008 to 2011

PPCI, primary percutaneous coronary intervention.Source: Widimsky P et al. Eur Heart J. 2010. Reproduced with permission from P Kala MD, PhD.

Nevertheless, Prof Kala emphasized that variation in the use of PPCI still persists among countries in Europe. However, he added that the initiative has expanded to address some specific factors, including sex disparities in patients' access to cardiovascular care and the early diagnosis and treatment of ACS, to increase female patients' access to reperfusion therapy. Cross-border issues are also being evaluated, he noted, because reimbursement of treatment and transport costs is a significant barrier to cross-border collaboration in the treatment of patients with STEMI.

The SFLI has launched a campaign called “ACT NOW. SAVE A LIFE,” which aims to improve the public's awareness of heart attack symptoms, urging people to act quickly and call emergency medical services to allow them to receive lifesaving PPCI treatment. However, despite its name, the SFLI is not solely focused on stent use; it is about reperfusion and improving patient care in general, Prof Kala concluded.