In search of lost time: modern treatment of acute myocardial

infarction.

Paweł Buszman, MD, FESC, FACC

Upper Silesian Heart Center

Katowice, Poland

Snowmass, Co 15.03.2007

ESC: STEMI/PCI Guidlines

24h/7d cath labs for AMI treatment:20 year experience!

Population of Upper-Silesia:

4,9 mln

50 km

KATOWICE: GCM, SLAM

Zabrze

AHP:Cath labs 1 mln.

Bielsko

Ustroń

Dąbrowa G.

Transportation:Max. 30 min. to the nearest cath lab

Częstochowa

Rybnik

American Heart of Poland, Ltdwww.klinikiserca.pl

Suspicion of ACS-ECG in ambulance

Transmission of ECG from ambulance to cath lab in a reference center

acceptation by interventional cardiologist

Reference center with cah lab

Local hospital

STEMI or High Risk ACS

ECG transmission through mobile phoneLIFE NET SYSTEM (MEDTRONIC)

Low risk ACS or non-coronary chest pain

American Heart of Poland, Ltdwww.klinikiserca.pl

American Heart of Poland, Ltdwww.klinikiserca.pl

American Heart of Poland, Ltdwww.klinikiserca.pl

Prox. LAD occlusion

Stent implantation

After stenting

American Heart of Poland, Ltdwww.klinikiserca.pl

American Heart of Poland, Ltdwww.klinikiserca.pl

In-hospital mortality vs treatment modalityIn-hospital mortality vs treatment modality

18,6%

9,7%

1,8%

17,3%

4,4%2,4% 0,3%

0,0%

5,0%

10,0%

15,0%

20,0%

25,0%

STEMI NSTEMI UA

PCI

Thrombolysis

Conservative

Silesian Registry of ACSSilesian Registry of ACSOctober 2003 – September 2004 (12 month)October 2003 – September 2004 (12 month)

8,4% 1,4%11,3%

30-day mortality30-day mortality

21,2%

11,5%

2,8%

19,1%

5,6%3,3% 0,5%

0,0%

5,0%

10,0%

15,0%

20,0%

25,0%

STEMI NSTEMI UA

PCI

Thrombolysis

Conservative

10,1% 2,2%13,0%

Silesian Registry of ACSSilesian Registry of ACSOctober 2003 – September 2004 (12 miesięcy)October 2003 – September 2004 (12 miesięcy)

Treatment strategy – Time – PrognosisTreatment strategy – Time – Prognosis

Time: Chest pain – hospital admission

30 day mortality

0-2 2-4 4-6 6-12 >120%

5%

10%

15%

20%

25%

30%

35%

40%

45%

Trombo liza Angioplas tyka w ieńcowa (PCI)

Silesian Registry of ACSSilesian Registry of ACSOctober 2003 – September 2004 (12 miesięcy)October 2003 – September 2004 (12 miesięcy)