EHS ACS III: Euro Heart Survey Acute Coronary Syndromes III 

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	Presenter
	Presenter | see Discussant report
Schiele, Francois (France)

List of Authors:
F. Schiele, M. Hochadel , M. Tubaro, N. Meneveau, W. Wojakowski, M. Gierlotka, L. Polonski, JP. Bassand, K.A.A. Fox, A. Gitt.

Abstract:

Aim:
The rate and type of reperfusion, as well as time delays to reperfusion are directly associated with mortality and are established as performance measures (PM) in the treatment of ST elevation myocardial infarction (STEMI). To date, little information exists about PM for reperfusion in clinical practice in Europe and their temporal changes.

Methods:
Using the Euro Heart Survey ACS-III dataset (2 years of inclusions between 2006 and 2008, 138 centres in 21 countries), we selected patients with STEMI eligible for reperfusion therapy. Recorded variables corresponded to the CARDS dataset. The rate and type of reperfusion, as well as door to needle and door to artery times were assessed and compared between periods. Timely reperfusion was defined as a door to needle time<30 min or a door to artery time <90 min. We assessed changes in PM for reperfusion over the 2 years of recruitment.

Results:
Among 19,205 patients included in the registry, 7,655 had STEMI and 6,481 were admitted within the first 12 hours and eligible for reperfusion. The rate of patients who underwent reperfusion increased from 77.2% to 81.3%, with an increase in the use of primary percutaneous coronary intervention (P-PCI). The door to needle and door to artery times decreased significantly during the study period, from 20 to 15 min (p<0.0011) and from 60 to 45 min (p<0.0001) respectively. As a result, the number of eligible patients receiving reperfusion therapy in a timely manner increased from 53.4% to 63.5% (p<0.0001). In parallel, over the 2 year period, in-hospital mortality decreased from 8.1% to 6.6%, p=0.047.

Conclusion:
In centres participating in the Euro Heart Survey ACS III, PM for reperfusion in STEMI improved significantly between 2006 and 2008, with greater use of PCI. Similarly, the rate of patients reperfused in a timely manner also increased, with a significant reduction in door to needle and door to artery times.
Funding: The EHS ACS III registry was funded by the European Society of Cardiology.

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	Discussant
	Discussant | see Presenter abstract
Danchin, Nicolas (France)

Report:

ST-elevation myocardial infarctions still carry a high mortality. The Euro Heart Survey ACS III analysed the trends in the use of reperfusion therapy, in the time delays to reperfusion and in mortality over a 2-year period of time in the 138 centres which included nearly 8,000 patients.

Overall, rates of reperfusion increased significantly, time to reperfusion decreased both for fibrinolysis and primary PCI, and mortality decreased. These encouraging results should not let us think that the fight for better management of STEMI patients is over.
In particular, it must be remembered:
1) that these results were achieved in very motivated centres and that the results observed in surveys with a larger number of participating centres are not as good
2) that the EHS ACS III results focus on patients hospitalised at a single centre (transfer patients are excluded), and that patients not reaching the hospital (mainly out-of-hospital cardiac arrests not resuscitated) are not included in such a survey.

The data are really encouraging as they show that, when motivated, clinicians can further improve the management of STEMI patients with a resultant decrease in mortality.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.