A campaign which will reduce mortality in patients with acute coronary syndromes has been launched today by a coalition which includes the ESC Working Group on Acute Cardiac Care and the European Association of Percutaneous Cardiovascular Interventions (EAPCI). "Stent 4 Life" is a project designed to encourage the wider use of reperfusion therapy with percutaneous coronary interventions (PCI, with balloon angioplasty and stent) in Europe. According to a new report introducing the campaign, it is the "unpredictable bursts" in coronary artery disease which lead to sudden ischaemic death, heart attack and unstable angina, and with them a sharp increase in mortality rate to more than 10%.(1)
Indeed, new European guidelines on the management of heart attack emphasise not only speed of action but also the importance of reperfusion to restore blood flow to the heart and improve survival rates.(2)
The Stent 4 Life campaign particularly addresses treatment of a common type of classical heart attack known as STEMI (ST-segment elevation acute myocardial infarction), a reference to its appearance on an ECG. Around one-third of all acute coronary events are diagnosed as STEMI, and the greater application of PCI (to rates above 600 per million population) "would enable us to address the needs of most patients suffering from STEMI across Europe".
The report adds: "The mission of the Stent 4 Life coalition is to promote the lifesaving indications of PCI, implying that priority will be given to targeting invasive resources to those patient groups who will benefit the most. Rather than attempting to enforce top down directives, the program will rely entirely on national Interventional Working Groups and Societies. Synergy, rather than competition, with existing initiatives will be the goal."
"There is first class evidence that primary PCI for acute STEMI is now the gold standard of care," says ESC spokesperson Professor Jean Fajadet, from the Clinique Pasteur in Toulouse, France. "But what we have seen is that its use in STEMI patients varies throughout Europe. In those countries with a high rate of PCI – such as Denmark, Poland, Czech Republic and the Netherlands – the number of untreated patients is low. Conversely, in countries with a low use of primary PCI the number of untreated patients is high."
The Stent 4 Life campaign aims to identify those countries where the use of primary PCI can be encouraged, and thereby the quality of care improved. The basis for the campaign is a questionnaire study with local cardiac societies in Europe and an assessment of individual requirements for a national programme. The recently announced National Infarct Angioplasty Project in the UK is one such action plan.
"We are convinced that this action will be of benefit to all," says the report. "Engaging in Stent 4 Life is simply the right thing to do, and at this early stage, we trust and rely on the active involvement of the entire interventional community."
Current registry data suggest that around 20-30 per cent of all STEMI patients in Europe still receive no reperfusion therapy. However, the report suggests that adherence to the guidelines and a greater use of primary PCI could dramatically improve STEMI patient survival.
NOTES FOR EDITORS
1. Widimsky P, Fajadet J, Danchin N, Wijns W. "Stent 4 Life". Targeting PCI at all who will benefit the most. A joint project between EAPCI, Euro-PCR, EUCOMED and the ESC Working Group on Acute Cardiac Care. EuroInterv.2009; 4: 555-557. Professor Petr Widimsky is co-chairman of the Stent 4 Life campaign; Professor William Wijns is President of EAPCI.
2. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation. Eur Heart J 2008; 29: 2909-2945.
The guidelines are also available online at http://www.escardio.org/guidelines-surveys/esc-guidelines//Pages/acs-st-segment-elevation.aspx
3. The guidelines describe primary PCI as "angioplasty and/or stenting without prior or concomitant thrombolytic therapy, and the preferred therapeutic option when it can be performed expeditiously by an experienced team."
4. Coronary heart disease is the single most common cause of death in Europe, accounting for 1.95 million deaths each year. Over one in five women (23%) and over one in five men (21%) die from the disease. Importantly, 14% of deaths before the age of 65 in men and 17% of deaths before the age of 65 in women are from CHD (European cardiovascular disease statistics, 2005).
* More information on this press release is available from the ESC Press office: press@escardio.org
Journal
EuroIntervention