Quality control project in ST elevation myocardial infarction
Stemi registration in Belgium
Acute heart attacks are a major healthcare problem with still high mortality and morbidity rates.
The major goal in the treatment of AMI is the rapid restoration of blood flow and myocardial perfusion in the infarct zone and this can be obtained either by pharmacological approach (fibrinolysis) or by mechanical approach (immediate coronary angiography and coronary dilatation of the occluded infarct artery, the so called primary PCI). Primary PCI has been shown to offer a substantial benefit over fibrinolysis (e.g. 30% reduction in mortality and re-infarction rate) at least if the procedure is performed by highly experienced operators and within 90 minutes after the first medical contact. For this reason rapid transfer to hospital with PCI facilities is mandatory especially for patients with large infarctions.
Thanks to applications of those more effective reperfusion strategies we can expect, according to the data of randomized trials, that the in hospital mortality should be less than 5% but, in daily practice, mortality remains above 10%. Possible reasons for these gap between reality and theory are still largely unknown but may include poor implementation of reperfusion strategies, long treatment delays, poor public awareness of heart attack. In addition data from RIZIV/ENAMI suggest a substantial variation in mortality among the Belgian hospitals possibly related to differences in patient population and/or patient treatment. A more complete knowledge of those factors and of outcome in patients with acute myocardial infarction is a prerequisite to improve the prognosis of heart attack in Belgium .
The college of cardiology together with the Belgian society of Cardiology and its working group on acute cardiology want to set up a minimal data base registry for ST elevation myocardial infarction in Belgian centres in order to identify more accurately factors of mortality in STEMI patients in Belgium and to help hospitals to adhere to guidelines by providing on-line benchmark reports to all individual centres. For 2007, data analysis will focus on issue of time to treatment and treatment modalities.
A number of baseline characteristics for each patient will be included which should allow to stratify the patients according to a previous validated TIMI risk score . In addition the register will include data about reperfusion strategy , transfer issues and data about in hospital mortality.
The registry will be governed by an independent software company specialised in electronic data capture solutions (Lambda-plus- website: http://www.lambdaplus.com ).
A multi-step program has been designed to implement this database in all Belgian centres with facilities for acute cardiac care. (A-B1-B2-B3 hospitals)
1. Pilot project (Q1-Q2 2006 ): collection of the mimimal data base of one patient per centre
• Realisation of prototype of web-based registry (Q3-Q4 2006).
• Initiation and installation of e-CRF in a limited number of centres (Q1 2007)
• Implementation of web-based registry in all Belgian centres (Q2 2007)
Organisation of regional meetings to explain the aim and practical organisation of the minimal data base
• Audit / control of e-CRF (Q3 2007)
• Analysis of data and reporting results ( Q4 2007)
Prof dr Marc Claeys
Project coordinator – member of college of cardiology