Winning the battle against ST-segment-elevation myocardial infarction: continued progress, but still a long way to go

This editorial refers to ‘Reperfusion strategy in Europe: temporal trends in performance measures for reperfusion therapy in ST-elevation myocardial infarction’[†][1], by F. Schiele et al ., on page 2614 With the Euro Heart Survey Acute Coronary Syndromes III (EHS ACS III) results presented in this issue of the Journal , Schiele et al. 1 are the bearers of good news. In their detailed analysis of the data gathered from 6481 patients admitted within 12 h of the onset of an ST-segment-elevation myocardial infarction (STEMI), the proportion of patients receiving reperfusion therapy increased from 77% in 2006 to 81% in 2008, while time delays from admission to reperfusion decreased [from 60 to 45 min for primary percutaneous coronary intervention (PCI), and from 20 to 15 min for intravenous fibrinolysis]. Concomitantly, in-hospital mortality decreased from 8.1% to 6.6%, a remarkable 19% relative decrease in just 2 years. These findings are important, as they show that improvement in the management of patients admitted for STEMI is still possible and they should be an incentive for continued efforts for all institutions and networks taking care of STEMI patients. The main strength of the study is that it was carried out in 138 highly motivated institutions across 21 European Society of Cardiology (ESC) member countries, which included patients according to a similar methodology for a period of 2 years, thereby making temporal comparisons possible with only limited risk of bias. In addition, the investigators used the Cardiology Audit and Registration Data Standards (CARDS) to collect the data according to common definitions,2 thereby ascertaining that the items recorded had exactly the same meaning in the different participating centres. The results presented can therefore be considered most reliable. But satisfying … [1]: #fn-2