El Dr. Helder Pereira Horta, presidente de la APIC, analiza la situación de la iniciativa europea Stent for Life/ACTP primaria en Portugal durante las Jornadas Nacionales sobre Angioplastia Primaria que se celebraron los días 3 y 4 de julio de 2014 en Ciudad Real.

1. Pereira H, SFL 2014
SITUACIÓN STENT FOR
LIFE/ACTP PRIMARIA EN
PORTUGAL
Hélder Pereira, SFL Champion
Ciudad Real, 4 Jul 2014

2. Pereira H, SFL 2014
Stent for Life Portugal
Where we started
Quality Assessment
Our Current Program
Market Research Study
Conclusion

3. Pereira H, SFL 2014
Where we started
3

4. Pereira H, SFL 2014
92
86
81 81
75 75 72 70
66 64
59
49
45 45
35 33 30 30 28 24 23 19 19
9 8 5
1
0 7
2 12
5
3
15
8 10
31
15
15
40
35
28
26
35
30
55
25
44
33
41
29
45
7
14 12
17 13
20
25
15
26 26
10
36
40
15
30
39
44
35
42
21
52
37
48 50
63
50
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
CZ SLO DE CH NO DK PL HR SE HU BE IL IT FIN AT FR SK ES LAT UK BG PO SRB GR TR RO
P-PCI Thrombolysis No reperfusion
Reperfusion Therapies Differ in Countries
(situation in years 2007-2008 for most countries)
Reperfusion therapy for ST elevation acute myocardial infarction in Europe:
description of the current situation in 30 countries.
P. Widimsky et al. Eur. Heart.J. 2010;31:943-957 doi:10.1093/eurheartj/ehp492
Stent for Life

5. Pereira H, SFL 2014
Reperfusion Therapies (<2008):
Reperfusion therapy for ST elevation acute myocardial infarction in Europe:
description of the current situation in 30 countries.
P. Widimsky et al. Eur. Heart.J. 2010;31:943-957 doi:10.1093/eurheartj/ehp492
Stent for Life
44%
19%
37%
Non
Revascularized
Primary PCI
Fibrinolysis
<200 P-PCI/million/year

6. Pereira H, SFL 2014
Reperfusion Therapies (2011):
Stent for Life
7%
68%
25%
Non
Revascularized
Primary PCI
Fibrinolysis
299 P-PCI/million/year*
Registo Nacional de SCA; SPC
* PNDCCV – Inquérito Unidades de Saúde 2011

7. Pereira H, SFL 2014
Barriers Identification
E.M.S. network
Communication
with P-PCI Centers
Secondary transport
Stent for Life Portugal
Patients
Only 23% of STEMI
patients call 112
Hospital
Strategic PCI Hospitals
w/o 24/7
Long “System Delay”Long “Patient Delay”
7

8. Pereira H, SFL 2014
Where we are

9. Pereira H, SFL 2014
Primary PCI Evolution
0
50
100
150
200
250
300
350
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013
105 118 125 132
152
179
228
243
264
299 306
334
From PNDCCV – Inquérito Unidades de Saúde 2013
* From APIC Survey 2013
P-PCI/ Million/Year 2002 - 2013
*

10. Pereira H, SFL 2014
Primary PCI vs Fibrinolysis
855
702
878
572
421 424 344
1616
1900
2415
2575
2829
3179 3246
0
500
1000
1500
2000
2500
3000
3500
4000
2006 2007 2008 2009 2010 2011 2012
Fibrinolysis
P-PCI
From PNDCCV – Inquérito Unidades de Saúde 2013
Coronary Care Units

11. Pereira H, SFL 2014
Primary PCI vs Other PCI
18 21 21 23 24 25 26
0%
20%
40%
60%
80%
100%
2007 2008 2009 2010 2011 2012 2013
P-PCI
Other

12. Pereira H, SFL 2014
Primary PCI per Regions (2012)
306 291
215
453
32
432
0
100
200
300
400
500
Continente Norte Centro LVT Alentejo Algarve
P-PCI 2012
From PNDCCV – Inquérito Unidades de Saúde 2013

13. Pereira H, SFL 2014
Primary PCI per Regions (2012)

14. Pereira H, SFL 2014
Primary PCI per Regions
(2012 vs 2013)
306
291
215
453
32
432
334
291 287
367
256
438
0
100
200
300
400
500
Continente Norte Centro LVT Alentejo Algarve
From PNDCCV – Inquérito Unidades de Saúde 2013

15. Pereira H, SFL 2014
Quality Assessment

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P-PCI/million/year
Quantity and Quality
Symptoms-FMC/
/Call 112
EMS
System Delay

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Quality Assessment
 Portuguese Registry of Interventional Cardiology
 “Moment” Survey
 Market Research Studies

18. Pereira H, SFL 2014
Portuguese Registry of
Interventional Cardiology (RNCI)
Since 2013, all P-PCI centers are sending data to RNCI

19. Pereira H, SFL 2014
Portuguese Registry of
Interventional Cardiology
Benchmark:

20. Pereira H, SFL 2014
Moment Zero (n=201)
May 2011
Moment One (n=196)
May 2012
Moment Two (n=244)
May 2013
“Moment” Survey
(SFL Portugal)

21. Pereira H, SFL 2014
Symptoms to FMC
0 20 40 60 80 100 120
Moment Zero
Moment One
Moment Two
118
102
90
Symptoms-FMC
Moment Zero
Moment One
Moment Two
(min)
May 2013
May 2012
May 2011

22. Pereira H, SFL 2014
Patients who called INEM
0%
10%
20%
30%
40%
Moment Zero Momento One Momento Two
33%
38% 37%
Call 112
May 2011 May 2012 May 2013

23. Pereira H, SFL 2014
Patients who underwent a health institution
without P-PCI
P=0,005
0%
10%
20%
30%
40%
50%
60%
70%
Moment Zero Moment One Moment Two
62%
47% 48%
LOCAL
HOSPITAL
May 2011 May 2012 May 2013

24. Pereira H, SFL 2014
“Door-in-Door-out” Time (DIDO)
85 90 95 100 105 110 115
Moment Zero
Moment One
Moment Two
97
106
115
LOCAL
HOSPITAL
P-PCI
HOSPITAL
P=0,051

25. Pereira H, SFL 2014
0 20 40 60
Moment Zero
Moment One
Moment Two
55
53
55
(min)
Time to Treatment
D2B

26. Pereira H, SFL 2014
Patients Arriving Directly to P-PCI Hospital:
50 min (30-75)
P-PCI
HOSPITAL
96 min (71-146)
P<0,001
“Door-to-Balloon”
(2011-2013)

27. Pereira H, SFL 2014
Triage Moment Zero Moment One Moment Two p
Red 5.4% (n=8) 10.6% (n=13) 5.7% (n=9) 0.184
Orange 77.7% (n=115) 66.7% (n=82) 78.3% (n=123) 0.042
Yellow 14.2% (n=21) 21.1% (n=26) 13.4% (n=21) 0.147
Other 2.7% (n=4) 1.6% (n=9) 2.5% (n=4) 0.852
Manchester Triage
30
17% 23% 16%

28. Pereira H, SFL 2014
Time to Reperfusion Therapy
0%
2%
4%
6%
8%
10%
12%
Moment Zero Moment One Moment Two
8%
12%
9%
Treatment Delay < 120 min:
May 2011 May 2012 May 2013

29. Pereira H, SFL 2014
Stent for Life Portugal
118
102
90
104
88
100
55
53
55
0 100 200 300
Moment Zero
Moment One
Moment Two
Symptoms-FMC FMC-PPCI D2B
Patient Delay System Delay
May 2013
May 2012
May 2011
Quality Control: Moment Surveys
(min)

30. Pereira H, SFL 2014
Market Research Study

31. Pereira H, SFL 2014
ACT NOW – SAVE A LIFE
What’s the typical symptom of MI?
24%
28%
27%
4%
5%
21%
Sintomas enumerados têm todos a ver com enfarte
Nenhum sintoma enumerado tem a ver com enfarte
Alguns dos sintomas enumerados têm a ver com
enfarte e outros sintomas não
Todos os sintomas enumerados têm a ver com AVC
Alguns dos sintomas enumerados têm a ver com
enfarte e outros têm a ver com AVC
Não sei qual o sintoma típico de enfarte
Symptoms related to MI
Any symptoms is related to MI
Some symptoms are related to MI, some other no
All symptoms are related to Stroke
Some symptoms are related to MI, some other are related to
stroke
Do not know the typical symptom of MI
Sofia Portela & Rui Menezes

32. Pereira H, SFL 2014
ACT NOW – SAVE A LIFE
What would you do in case of MI ?
0%
1%
6%
91%
2%
Chamava um médico
Telefonava a um familiar ou amigo
Ia para o hospital de carro
Chamava uma ambulância
Outro
Other…
• Call line Saúde 24
• Press chest
• Basic life support
• Don’t know
Call a doctor
Call a friend or relative
Go to a hospital by car
Call an ambulance
Other
Sofia Portela & Rui Menezes

33. Pereira H, SFL 2014
ACT NOW – SAVE A LIFE
3%
95%
1% 0% 1% 0% 0%
Não sei 112 115 117 118 119 202
What’s the emergency number?
Sofia Portela & Rui Menezes
Don’t know

34. Pereira H, SFL 2014
Patients who called INEM
0%
10%
20%
30%
40%
Moment Zero Momento One Momento Two
33%
38% 37%
Call 112

35. Pereira H, SFL 2014
Our Current Program

36. Pereira H, SFL 2014
Stent for Life Programs
Secondary
Prevention
Follow
the
STENT
Primary
Prevention
STENT
goes to
School
Cost-
-Effectiveness
Study
SSAVE HER LIFE

37. Pereira H, SFL 2014
Regional Meetings
(P-PCI Hospitals, Non-PCI
Hospitals, EMS, Regional
Authorities)
North: Jorge Marques
Centre: Marco Costa
Lisbon and Vale do Tejo: Pedro Sousa
Alentejo: Renato Fernandes
Algarve: Jorge Mimoso
North
Center
LVT
Alentejo
Algarve

38. Pereira H, SFL 2014

39. Pereira H, SFL 2014
Barriers Identification
E.M.S. network
Communication
with P-PCI Centers
Secondary transport
Conclusions
Patients
Only 23% of STEMI
patients call 112
Hospital
Strategic PCI Hospitals
24/7
Long “System Delay”Long “Patient Delay”

40. Pereira H, SFL 2014
Thank you