Improving STEMI Management Internationally
Background: The burden of ST-segment elevation myocardial infarction (STEMI) worldwide is increasing as the leading cause of death; there are scant data on system-based initiatives and performance metrics relative to its management in low- and middle-income countries where resources are frequently l...
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| Format: | Article |
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Elsevier
2025-01-01
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| Series: | JACC: Advances |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2772963X2400718X |
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| author | Cesar J. Herrera, MD Benny J. Levenson, MD, PhD Angela Natcheva Ana Corina Lucca, BA Kelly Olsson, MA Kyoko Miki, BS Alan Fong, MD James G. Jollis, MD Alyssa McCormick, BA, MBA B. Hadley Wilson, MD |
| author_facet | Cesar J. Herrera, MD Benny J. Levenson, MD, PhD Angela Natcheva Ana Corina Lucca, BA Kelly Olsson, MA Kyoko Miki, BS Alan Fong, MD James G. Jollis, MD Alyssa McCormick, BA, MBA B. Hadley Wilson, MD |
| author_sort | Cesar J. Herrera, MD |
| collection | DOAJ |
| description | Background: The burden of ST-segment elevation myocardial infarction (STEMI) worldwide is increasing as the leading cause of death; there are scant data on system-based initiatives and performance metrics relative to its management in low- and middle-income countries where resources are frequently limited. Objectives: The Global Heart Attack Treatment Initiative (GHATI) ultimate aim is improving evidence-based STEMI care, adherence to guidelines, and tracking of clinical and institutional indicators in low- and middle-income countries. To achieve that goal, the process of care and outcomes of STEMI patients in those nations will be studied. Methods: In this initial phase of GHATI (2019-2021), prospective analyses of selected STEMI metrics derived from the American College of Cardiology Chest Pain MI Registry were undertaken in 18 international hospitals, most located in developing countries unfamiliar with quality improvement metrics. Results: Of 4,092 patients enrolled, complete data were available in 3,914 consecutive STEMIs included here: 80.5% male; 35.5% smokers; shock on arrival in 10%; and 5.1% with cardiac arrest before intervention. Overall, a 2% improvement on combined endpoints (shock; arrest before or after intervention; final ejection fraction <40%; survival at discharge) was observed over time, and survivorship also increased by 2% (P = 0.003). First medical contact to device time <90 minutes occurred in 74.8%; reperfusion therapy in 94.2%; and adherence to guidelines in 91.8%. Conclusions: This global contemporary registry successfully enrolled STEMI patients in nations generally unfamiliar with quality improvement metrics; trends of improvement in their care were observed. GHATI may facilitate implementation of policies aimed at enhancing outcomes of cardiovascular disease worldwide, particularly in countries with evolving economies. |
| format | Article |
| id | doaj-art-e587605b940d4f3c85eedb6919445c85 |
| institution | DOAJ |
| issn | 2772-963X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | JACC: Advances |
| spelling | doaj-art-e587605b940d4f3c85eedb6919445c852025-08-20T02:49:57ZengElsevierJACC: Advances2772-963X2025-01-014110143810.1016/j.jacadv.2024.101438Improving STEMI Management InternationallyCesar J. Herrera, MD0Benny J. Levenson, MD, PhD1Angela Natcheva2Ana Corina Lucca, BA3Kelly Olsson, MA4Kyoko Miki, BS5Alan Fong, MD6James G. Jollis, MD7Alyssa McCormick, BA, MBA8B. Hadley Wilson, MD9CEDIMAT Cardiovascular Center, Santo Domingo, Dominican Republic, and Montefiore-Einstein Center for Heart and Vascular Care, New York, USA; Address for correspondence: Dr Cesar J. Herrera, C/Pepillo Salcedo, Plaza de la Salud, Santo Domingo, Dominican Republic.Cardiovascular Center Berlin-Charlottenburg, and Cardiology Dept. Klinikum Am Urban Vivantes, Berlin, GermanyAmerican College of Cardiology, Washington DC, USAAmerican College of Cardiology, Washington DC, USAAmerican College of Cardiology, Washington DC, USAAmerican College of Cardiology, Washington DC, USADepartment of Cardiology, Sarawak Heart Centre, Kota Samarahan, MalaysiaDepartment of Cardiology, Duke University Medical Center, Durham, North Carolina, USAAmerican College of Cardiology, Washington DC, USASanger Heart and Vascular Institute/Atrium Health, Charlotte, North Carolina, USABackground: The burden of ST-segment elevation myocardial infarction (STEMI) worldwide is increasing as the leading cause of death; there are scant data on system-based initiatives and performance metrics relative to its management in low- and middle-income countries where resources are frequently limited. Objectives: The Global Heart Attack Treatment Initiative (GHATI) ultimate aim is improving evidence-based STEMI care, adherence to guidelines, and tracking of clinical and institutional indicators in low- and middle-income countries. To achieve that goal, the process of care and outcomes of STEMI patients in those nations will be studied. Methods: In this initial phase of GHATI (2019-2021), prospective analyses of selected STEMI metrics derived from the American College of Cardiology Chest Pain MI Registry were undertaken in 18 international hospitals, most located in developing countries unfamiliar with quality improvement metrics. Results: Of 4,092 patients enrolled, complete data were available in 3,914 consecutive STEMIs included here: 80.5% male; 35.5% smokers; shock on arrival in 10%; and 5.1% with cardiac arrest before intervention. Overall, a 2% improvement on combined endpoints (shock; arrest before or after intervention; final ejection fraction <40%; survival at discharge) was observed over time, and survivorship also increased by 2% (P = 0.003). First medical contact to device time <90 minutes occurred in 74.8%; reperfusion therapy in 94.2%; and adherence to guidelines in 91.8%. Conclusions: This global contemporary registry successfully enrolled STEMI patients in nations generally unfamiliar with quality improvement metrics; trends of improvement in their care were observed. GHATI may facilitate implementation of policies aimed at enhancing outcomes of cardiovascular disease worldwide, particularly in countries with evolving economies.http://www.sciencedirect.com/science/article/pii/S2772963X2400718XAMI registryinternationalSTEMI |
| spellingShingle | Cesar J. Herrera, MD Benny J. Levenson, MD, PhD Angela Natcheva Ana Corina Lucca, BA Kelly Olsson, MA Kyoko Miki, BS Alan Fong, MD James G. Jollis, MD Alyssa McCormick, BA, MBA B. Hadley Wilson, MD Improving STEMI Management Internationally JACC: Advances AMI registry international STEMI |
| title | Improving STEMI Management Internationally |
| title_full | Improving STEMI Management Internationally |
| title_fullStr | Improving STEMI Management Internationally |
| title_full_unstemmed | Improving STEMI Management Internationally |
| title_short | Improving STEMI Management Internationally |
| title_sort | improving stemi management internationally |
| topic | AMI registry international STEMI |
| url | http://www.sciencedirect.com/science/article/pii/S2772963X2400718X |
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