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No reperfusion therapy is still a major problem in Europe

Substantial numbers of patients in particular in Eastern and Southern Europe do not receive any reperfusion therapy after ST-segment elevation myocardial infarction (STEMI), according to a Stent for Life (SFL) survey of 37 ESC countries.

Amsterdam, The Netherlands – Tuesday 3 September 2013: Substantial numbers of patients in particular in Eastern and Southern Europe do not receive any reperfusion therapy after ST-segment elevation myocardial infarction (STEMI), according to a Stent for Life (SFL) survey of 37 ESC countries. The problem of no reperfusion therapy was greatest in Bosnia Herzegovina, Bulgaria, Serbia and Ukraine. The full results of the survey were presented for the first time at the ESC Congress today by Professor Steen Kristensen (Denmark).
Primary percutaneous coronary intervention (PPCI) is recommended as the first choice of treatment in patients with STEMI.1 But a survey published in 2009 (based on 2007/2008 data) revealed that many STEMI patients received thrombolysis and a large group did not receive any reperfusion therapy.2
The SFL Initiative3 was established in 2008 to drive equal access to life saving PPCI in STEMI patients across Europe. A new survey, published today, reveals the status of reperfusion therapy in patients admitted with STEMI in 37 of the 53 ESC member countries. Professor Kristensen said: “We conducted the survey to identify countries that still have a low uptake of PPCI, and countries where there is a high percentage of patients not getting any reperfusion therapy.”  
This cross-sectional descriptive study was based on aggregated country level data on patients admitted with STEMI during 2010 or 2011. Data was collected on the use of reperfusion treatment and mortality, the numbers of cardiologists and the availability of PPCI facilities. Information came from national or regional registries, or from expert estimates when registries did not exist.
Overall, the survey demonstrated large variations in the management of STEMI patients in the 37 countries. During 2010 and 2011, a substantial number of STEMI patients in Eastern and Southern Europe did not receive any reperfusion therapy. These numbers were highest in Bosnia Herzegovina, Bulgaria, Serbia and Ukraine (e.g. in Ukraine this number was 526 per million inhabitants).
The number of PPCI per million inhabitants ranged from 23 in Saudi Arabia to 938 in The Netherlands. PPCI was the dominant reperfusion strategy in 33 countries but thrombolysis was still the treatment of choice in 4 countries (Bosnia Herzegovina, Cyprus, Greece and Serbia).
Professor Kristensen said: “Overall there is improvement since the last survey but there is still quite a lot of work to do in several countries. PPCI is the best therapy but if it isn’t available then thrombolysis is an acceptable option. The worst case scenario is when patients do not get any reperfusion therapy.”

All countries reported large increases since 2007/2008 in the number of catheterization laboratories providing PPCI services 24 hours a day, 7 days a week. The average population size served by a single PPCI centre with 24/7 services ranged from 31,300 inhabitants per centre in San Marino to 6,533,000 inhabitants per centre in Saudi Arabia.
As previously reported at EuroPCR, the survey reveals that PPCI use increased dramatically between 2007 and 2011 in the six countries enrolled in the SFL Initiative in 2009. During this period, PPCI use increased from 23% to 57% in Bulgaria, 33% to 64% in France, 9% to 32% in Greece, 19% to 44% in Serbia, 30% to 50% in Spain and 8% to 78% in Turkey. As PPCI use rose in the six countries, the percentage of patients not receiving any reperfusion therapy decreased.
Professor Kristensen concluded: “PPCI is the first choice of treatment in most countries but more work is needed to ensure equal access for all patients. The SFL Initiative will continue to help countries identify their own barriers to implementing guidelines (e.g. poor access to emergency health services, economic factors or lack of trained doctors) and find ways of increasing their use of life saving PPCI.”


  1. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. European Heart Journal. 2012;33:2569–2619.
  2. Widimsky P, et al. Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries. European Heart Journal. 2010;31(8):943-57. doi:10.1093/eurheartj/ehp492. Epub 2009 Nov 19.
  3. About Stent for Life
Stent for Life (SFL) is an initiative of the European Association of Percutaneous Cardiovascular Interventions (EAPCI), a registered branch of the ESC and EuroPCR. SFL aims to improve the delivery of care and patient access to the life saving indications of primary percutaneous  coronary intervention (PPCI), thereby reducing mortality and morbidity in patients suffering from acute coronary syndromes. See for more information and a list of participating countries.

This press release accompanies a presentation at the ESC Congress 2013. The press release has been approved by the Past Chairman of the Initiative.

Notes to editor

About the European Society of Cardiology
The European Society of Cardiology (ESC) represents more than 80 000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.
About ESC Congress 2013
The ESC Congress is currently the world’s premier conference on the science, management and prevention of cardiovascular disease.  The spotlight of this year's event is "The Heart Interacting with Systemic Organs".  ESC Congress 2013 takes place from 31 August to 4 September at the RAI centre in Amsterdam, Netherlands. More information on ESC Congress 2013 contact the ESC Press Office.