Implementation of a Regional STEMI Network in North Cairo (Egypt): Impact on The Management and Outcome of STEMI Patients.

Background: Regional ST-segment-elevation myocardial infarction (STEMI) networks facilitate timely performance of primary percutaneous coronary intervention (PPCI), reduce mortality and improve outcomes. Few data exist on the feasibility and impact of regional STEMI networks in developing countries. Aim of the Work: The aim of this study was to examine the feasibility and impact of establishing a regional STEMI network on the management and outcomes of STEMI patients in north Cairo. Patients and Methods: A prospective observational study conducted on 352 patients presenting in North Cairo with confirmed diagnosis of STEMI within 48 hours of symptoms. Patients were divided into group I (n = 140) before and group II (n = 212) after establishment of the STEMI network. Both groups were compared as regards patients' demographics, presentation, management and short-term outcomes. The north Cairo regional STEMI network was established among four governmental hospitals and the governmental ambulance was used for interhospital transfer. WhatsApp® was used for trans-network team communication. Results: Mean age of the study population was 55.4 ± 11.02 years and 286 (81.3%) were males. Mean time from chest pain to first medical contact did not change between the two groups (240 minutes; P = 0.36) while door to balloon mean time was reduced (from 54.3 to 44.1 minutes: P = 0.01). Use of thrombolytic therapy declined from 51 (36.4%) to 16 (7.5%) (P < 0.001) while primary PCI increased from 59.8% to 77.1% (p < 0.001). Left ventricular ejection fraction improved from 51.3 ± 10.7 to 55.4 ± 9.1 (P < 0.001), the mean time of CCU stay was reduced from a mean of 3.0 to 2.0 days (P < 0.001) and in-hospital mortality improved from 6.4% to 2.8% (P = 0.10). Conclusion: The establishment of the STEMI network in north Cairo was feasible and improved patients' outcomes. Use of primary PCI increased and in-hospital mortality improved from after establishment of STEMI network.

Prevention of contrast induced nephropathy by ischemic preconditioning in patients undergoing percutaneous coronary angiography.

BACKGROUND: Contrast-induced nephropathy (CIN) is the acute deterioration of renal function after parenteral administration of radio contrast media in the absence of other causes. The true incidence of CIN varies because of differences among the published studies in the definition of CIN, the proportion of high-risk patients, the types of contrast media, and the use of preventive measures. Remote ischemic preconditioning (IPC) may offer a non-pharmacological prevention strategy for lowering CIN in patients undergoing coronary procedures. The assumption that IPC produces protective effects on tissues or organs by multiple brief cycles of ischemia and reperfusion applied to another remote tissue or organ. AIM: To investigate the effect of ischemic preconditioning in prevention of CIN in patients with renal impairment undergoing percutaneous coronary angiography. RESULTS: In this study, 100 patients undergoing elective PCI with a base line creatinine clearance <60 ml/min were studied. Patients were divided into two equal groups (ischemic preconditioning group and control group). The incidence of CIN was markedly lower in ischemic preconditioning group 14% VS 38% in control group. The incidence of CIN difference as was found to be (24%). Amount of dye used, decreased LVEF and presence of a significant LAD lesion were significant risk factors for occurrence of CIN. CONCLUSIONS: The current study showed that remote ischemic preconditioning plays an important role in prevention of CIN in patients undergoing PCI with renal impairment GFR < 60 ml/min. The amount of contrast, decreased LVEF, and presence of LAD significant lesion were significant risk factors for developing of CIN and these subgroups benefited from application of ischemic preconditioning.

Stent for Life Initiative placed at the forefront in Egypt 2011.

AIMS: Myocardial infarction is a medical emergency in which 25 to 35% of patients will die before receiving medical attention. The Stent for Life registry was launched to access the current situation of the Egyptian population presenting with STEMI, and to determine what were the barriers to providing patients with cardiac problems appropriate care. METHODS AND RESULTS: This registry was conducted at 14 centres covered all the Egyptian regions including 1,324 consecutive patients presenting with STEMI during the period between January 1st, 2011 to November, 2011. Fourteen centres and 38 interventionalists participated in this registry; only six centres are Pilot Centres (fulfilling the criteria for a primary PCI centre) and were assigned at the end of 2011. Cardiovascular risk factors were mainly smoking (60.5%), dyslipidaemia (46.0%), diabetes (51.4%) and hypertension (56.0%). The mean age at presentation was 56.01±10.61years and 75.0% were male. Only 5% of the STEMI patients arrived via the emergency medical system. Thrombus aspiration was done in 42.7% of patients in primary PCI group and 25.9% in rescue PCI group. Bare metal stents (BMS) were used in 80.7% of the stented patients while drug eluting stents (DES) were used in 19.3% of the stented patients. In-hospital mortality was 2.9% (1.4% in primary PCI group, 1.1% in patients treated with thrombolysis and 0.4% in patients receiving no reperfusion therapy). CONCLUSION: Despite the logistical difficulties, excellent outcomes for acute interventional reperfusion strategy in STEMI can be achieved in our country, possibly similar to those seen in the West. There is a strong need for making the practice of PCI in STEMI more widespread in developing regions.