• Interventional Techniques & Devices
• Interventional Radiology
• Myocardial Infarction
• Cardiology Clinical Trials

Almost 2 years ago, Egypt was chosen to be 1 of 10 countries to participate in the international Stent for Life (SFL) Initiative. The mission of the SFL Initiative in Egypt, presented by Mohamed Sobhy, MD, Alexandria University, Alexandria, Egypt, is to improve delivery and patient access to the life-saving indications of percutaneous coronary intervention (PCI), thereby reducing the mortality and morbidity of patients suffering from acute coronary syndromes.

Before the initiative, there was no consistent pathway for a patient experiencing an acute myocardial infarction (AMI) to access medical care. The patient might call a cardiologist, private hospital, private insurance physician, or emergency medical system (EMS). Only ambulances from specialized cardiac hospitals had a physician on board, and most of them were not properly trained. Electrocardiograms were only available in new ambulances. With no clear unified protocol, patients were taken to the nearest hospital. Additionally, cardiac catheterization labs were not prepared to treat AMI patients and not all were open 24/7. Before the initiative, only 8% of AMI patients in Egypt were treated with primary PCI (p-PCI) and more than 60% did not receive any reperfusion therapy. With the SFL initiative, Egypt aims to increase p-PCI to about 22%.

Implementation of the SFL Initiative began with work on physician education, patient education, EMS staff and problems, creation of an Egyptian Registry, and pilot PCI center detection. The first phase of the Egyptian SFL registry took place from May 2011 to January 2012. During this phase, a total of 1324 patients with ST-segment elevation MI (STEMI) were hospitalized. At the time there were 35 PCI hospitals, 20 of which had 24/7 primary PCI service. The mean time from symptom onset to first medical contact for all STEMI patients was 600 minutes. The mean time from first medical contact to the PCI center was 120 minutes; first medical contact to thrombolysis treatment was 420 minutes; PCI center arrival to p-PCI was 70 minutes.

PCI procedures were performed in 820 of the 1324 STEMI patients, with 688 (52%) p-PCI procedures (Table 1). A total of 21 (1.6%) patients received coronary artery bypass grafts; 18 (1.4%) received coronary angiography and medical treatment; 93 (7.0%) received medical treatment with no reperfusion. A total of 504 patients were treated with thrombolysis, with 147 (11.1%) undergoing rescue procedures, while 21 (1.6%) were treated with thrombolysis as part of a pharmaco-invasive approach. Of the 688 primary PCI procedures, GPIIb IIIa inhibitor was used in 424 patients (61.7%); thrombus aspiration was performed in 294 patients (42.7%); 545 patients (79.2%) received a bare metal stent.

The SFL-Egypt Action Plan for 2012 is shown in Table 2. The SFL public campaign will call on all members of the public to “look after the hearts of those that are close to them” to raise awareness among family, friends, colleagues, and social and business groups. Individuals and groups will be educated on the signs of a heart attack, the importance of acting quickly and calling an ambulance, and the benefits of p-PCI. Partners in the first phase of the public awareness campaign include medical, government, and industry organizations.

The SFL-Egypt mission for 2012 includes guidelines implementation and physician education, registry and questionnaire/database collection, pilot centers detection, media campaign; public/patient awareness campaign, and preparation of an Egyptian SFL map.

• © 2012 MD Conference Express®