Abstract 20678: A Systematic Review of World-Wide Characteristics and Management of Patients With ST-Segment Elevation Myocardial Infarction

Background: Management of ST elevation myocardial infarction (STEMI) has made tremendous progresses during the last decades. However, it remains uncertain whether all STEMI patients are receiving optimal care and whether variation in care has any impact on their outcomes. We aim to characterize the contemporary global characteristics, managements, and outcomes of STEMI patients. Methods and Results: We searched EMBASE/MedLINE Ovid for observational data of patients with STEMI. We identified 17 studies enrolling 112 772 patients in 20 countries during the last 5 years (2008-2013). The median age ranged from 54 to 66 years with 13%-33% females. Twelve percent to 39% of patients presented in Killip heart failure class 2-4. In-hospital use of aspirin (ASA), P2Y12 inhibitor/thienopyridines, and systemic anticoagulation was 90-99%, 77-97%, and 61-100% respectively. Reperfusion was provided for 63%-97% of patients. Fibrinolysis was used in 0.7%-66% with a door-to-needle (D2N) time of 28-65 minutes; 12%-74% with D2N <30minutes. Primary percutaneous coronary intervention was performed for 17%-97% with a door-to-balloon (D2B) time of 40-125 minutes; 40%-94% had D2B <90 minutes. Emergency cardiac surgery was performed in 0.4%-8% of patients. Discharge prescriptions included ASA, thienopyridines/P2Y12 inhibitors, beta-blockers, and statins in 85%-99%, 77%-97%, 54%-83%, and 64%-95% respectively. In-hospital outcomes included death (2%-10%), recurrent myocardial infarction (0.4%-5%), stroke (0.2%-1.6%), major bleeding (0.3%-7%). The median hospital stay ranged from 4-6 days. Conclusion: Despite recent progresses in STEMI care, there remains marked heterogeneity in STEMI care and outcomes worldwide that warrants further attention. Identification of gaps to STEMI care and remedial actions may improve the global outcomes of STEMI patients.