QUALITY OF CARE FOR PATIENTS WITH MYOCARDIAL INFARCTION WITH ST SEGMENT ELEVATION. REAL CLINICAL PRACTICE OF THE SIBERIAN INVASIVE CENTER

Background. There are many quality indicators for evaluation of quality of care in patients with myocardial infarction in the USA and Europe, but no such indicators exist in Russia.
Material and Methods. This retrospective study included 475 STEMI patients, admitted within the first 12 hours during 2016. The baseline characteristics and treatment of our STEMI patients were compared with the OPERA register (France). The quality of care in STEMI patients was assessed using the quality criteria of the Association of Acute Cardiovascular Care of the European Society of Cardiology. Thrombolytic therapy, primary PCI, cardiogenic shock, pulmonary edema, acute LV aneurysm, and acute psychotic disorders were endpoints for a comparative assessment of quality of care in different age groups.
Results. The following was more frequent among patients of our center: female, history of MI, hypertension, dyslipidemia and smoker. Our patients were less likely to receive primary PCI and GP IIb/IIIa inhibitor, but more often thrombolytic therapy, LMWH, aspirin, inhibitor P2Y12, beta-blocker, ACEI/ARBs and statins. All eligible STEMI patients received reperfusion and recommended medication, but hospital mortality was higher than in the OPERA register (7.4% versus 4.6%; p<0.05). Senile STEMI patients are less likely to undergo invasive reperfusion due to severe comorbidity, dementia and acute psychotic disorders, which leads to a manifold increase in hospital mortality.
Conclusion. It is necessary to develop new devices for PCI of calcinated lesions, and methods for neuroprotection to overcome the existing barriers to ensure high-tech care in senile STEMI patients.

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