Stent for Life Initiative Improves Delivery of Primary PCI in Timely Manner

Mary Mosley

doi:10.1177/155989771307014

Summary

The Stent for Life program is a joint initiative to improve the delivery of and patient access to percutaneous coronary intervention to reduce the morbidity and mortality of patients suffering from acute coronary syndromes. This article reviews the objectives of Stent for Life and the three stages completed to date.

Myocardial Infarction
Interventional Techniques & Devices

Cardiology & Cardiovascular Medicine
Myocardial Infarction
Interventional Techniques & Devices

The Stent for Life (SFL) program is a joint initiative to improve the delivery of and patient access to percutaneous coronary intervention (PCI) to reduce the morbidity and mortality of patients suffering from acute coronary syndromes (ACS). The founding partners in this program are the European Association of Percutaneous Cardiovascular Interventions (EAPCI), a registered branch of the European Society of Cardiology, and EuroPCR. Petr Kala, MD, Brno, Czech Republic, SFL Chairman, reviewed the objectives of Stent for Life and the three stages completed to date.

The objectives of Stent for Life Initiative are to define the regions and countries with an unmet medical need for optimal treatment of ACS, and to implement an action program to increase patient access to primary PCI where it is needed. In terms of patient access, the goals are to increase primary PCI to >70% among all patients with ST-segment elevation myocardial infarction (STEMI) and to provide 24/7 service for primary PCI at all invasive facilities to meet the needs of the STEMI population.

Phase 1 of Stent for Life comprised situation mapping and data collection during 2008 and 2009 to assess the current situation in 30 countries. Along with defining the rates of primary PCI, thrombolysis, and no reperfusion for STEMI, they found that the rates of primary PCI were not correlated to gross domestic product of the country [Widimsky P et al. Eur Heart J 2010]. On average, only 51% of STEMI patients arrive to the first hospital by emergency medical services (EMS), and 46% of STEMI patients were untreated despite a nationwide “thrombolytic strategy” program.

Phase II evaluated how to improve access to primary PCI based on the experience of best practice countries. Strategies found to reduce system delays included building an effective primary PCI network, strengthening the role of EMS, and decreasing transportation time. An awareness campaign called “ACT NOW. SAVE A LIFE” was created to educate public about heart attack symptoms and the need to act and call an emergency number to reduce patient delay in seeking medical treatment [Knot J et al. EuroIntervention 2009].

The implementation of Stent for Life from 2009 to 2013 comprised Phase 3. Currently there are 17 national cardiac societies and organizations actively involved in SFL in Europe and Asia. Prof. Kala reviewed the achievements attained in Romania, which joined SFL in 2010. Five STEMI networks with 10 hospitals with cardiac catheterization labs were identified to provide 24/7 primary PCI service under this government program.

An additional eight primary PCI centers will be opened by 2015 [Kristensen SD et al. EuroIntervention 2012]. The Romanian national program has resulted in an increase of patients treated with primary PCI, decreases in the utilization of thrombolysis, and a decrease in the number patients with STEMI who do not undergo reperfusion therapy. The number of primary PCIs performed increased from 40 per million inhabitants in 2009, to 64 in 2010, and to 210 in 2011.

The Stent for Life program identified factors that contribute to the delay in treating STEMI patients and targets for providing intervention (Figure 1). The first factor found to delay the timing of therapy was the length of time between the onset of a patient's symptoms to the first medical contact. Public service campaigns designed to increase awareness of symptoms of myocardial infarction have been developed to reduce this potential for delay in therapy. Efforts of the Stent for Life program have focused on reducing the delays in reperfusion that can occur after patients present to the healthcare system.