Comparison of Real-Life Systems of Care for ST-Segment Elevation Myocardial Infarction

Country	Current achievement of reperfusion therapy	Source of data
Europe
France, (N = 14,423)	Use of primary PCI increased from 12% in 1995 to 76% in 2015.	FAST-MI registry
Vienna, (N = 1053)	Two years after STEMI network introduction, reperfusion therapy increased from 66% to 87%, and the proportion of non-reperfused patients reduced from 34% to 13.4%.	Vienna STEMI registry
United States, (N = 147,466)	– Improvement of DTD and DI-DO times in 2012 compared with 2008 (median 59 min versus 68 min, and median 62 min versus 76 min, respectively) – Use of fibrinolytic therapy and non-reperfused patients declined in 2012 compared with 2008 (7% versus 13.4% and 3.3% versus 6.2%, respectively).	Mission: Lifeline programme
Russia, (N = 85,496)	Use of primary PCI and fibrinolysis therapy were 24% and 27.6 %, respectively.	Russian Acute Coronary Syndrome Registry
Australia, (N = 4110)	Rate of primary PCI was not increase over time but access to non-PCI center was increasing.
Asia
India (southern state of Tamil Nadu), (N = 2420)	A hub-and-spoke model improved STEMI care by higher utilization of primary PCI.	Local registry
China, (N = 13,815)	Use of primary PCI increased from 10.6% in 2001 to 28.1% in 2011.	China PEACE-Retrospective Acute Myocardial Infarction Study
Indonesia (Jakarta), (N = 1676)	– Use of primary PCI increased from 28% in 2008/2009 to 56% in 2015/2016. – the median DTD time improved from 94 min to 82 min.	Jakarta Acute Coronary Syndrome Registry
Korea, (N = 32,211)	– The symptom onset-to-balloon time has gradually decreased from 257 min in 2008 to 189 min in 2018. – The door-to-balloon time reduced from 72 min in 2008 to 60 min in 2012, and remained at approximately 60 min since 2012 to 2018.	Korea Acute Myocardial Infarction Registry
Japan, (N = 20,462)	– Rates of ambulance use and primary PCI were 78.9% and 87.9%, respectively. – The median time from symptom onset-to-balloon time and median door-to-balloon time were 230 min and 80 min, respectively.	Japan Acute Myocardial Infarction Registry
Singapore, (N = 4667)	– Less than half of STEMI patients (49.8%) utilized EMS transport. – Patients who used EMS transport were associated with higher rate of reperfusion therapy, and resulted to shorter median symptom onset-to-balloon and door-to-balloon times.	Singapore Myocardial Infarction Registry
Middle East, (N = 2233)	Use of fibrinolysis therapy and primary PCI were 29% and 42.5%, respectively.	Saudi Acute Myocardial Infarction Registry
Latin America
Brazil, (N = 520)	Use of telemedicine in a regional STEMI network increased primary reperfusion procedures (53.8% versus 29.1%), and more patients transferred to referral hospitals (76.3% versus 44.7%).	Salvador’s STEMI registry (RESISST)

[i] PCI denotes percutaneous coronary intervention; STEMI, ST-segment elevation myocardial infarction; DTD, door-to-device; DI-DO, door-in to door-out; EMS, emergency medical service; N indicates number of patients included in the study.

Table 3

Trends in primary PCI in European STEMI networks. [34].

Countries	2010	2011	2012	2013	2014	2015
Belgium	NA	4,365	NA	4,088	4,399	4,817
Denmark*	309	390	403	400	404	433
Israel	1,574	1,640	1,780	1,773	1,802	1,820
Italy	27,908	28,514	30,038	31,957	32,557	33,895
Kazakhstan	347	365	1,180	1,694	1,886	2,368
Macedonia	763	747	735	1,001	1,291	1,175
Poland	25,634	28,060	28,278	26,681	26,678	30,163
Portugal	1,773	2,230	2,952	3,155	3,121	3,267
Serbia	2,676	3,493	3,834	4,239	4,743	5,093
Spain	10,339	11,766	13,690	13,890	14,679	15,089
Sweden	4,646	4,559	4,576	4,666	4,929	4,902
Switzerland	3,985	3,639	3,139	3,084	3,393	3,825