JACC: Advances (Jan 2025)

Improving STEMI Management Internationally

  • Cesar J. Herrera, MD,
  • Benny J. Levenson, MD, PhD,
  • Angela Natcheva,
  • Ana Corina Lucca, BA,
  • Kelly Olsson, MA,
  • Kyoko Miki, BS,
  • Alan Fong, MD,
  • James G. Jollis, MD,
  • Alyssa McCormick, BA, MBA,
  • B. Hadley Wilson, MD

Journal volume & issue
Vol. 4, no. 1
p. 101438

Abstract

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Background: The burden of ST-segment elevation myocardial infarction (STEMI) worldwide is increasing as the leading cause of death; there are scant data on system-based initiatives and performance metrics relative to its management in low- and middle-income countries where resources are frequently limited. Objectives: The Global Heart Attack Treatment Initiative (GHATI) ultimate aim is improving evidence-based STEMI care, adherence to guidelines, and tracking of clinical and institutional indicators in low- and middle-income countries. To achieve that goal, the process of care and outcomes of STEMI patients in those nations will be studied. Methods: In this initial phase of GHATI (2019-2021), prospective analyses of selected STEMI metrics derived from the American College of Cardiology Chest Pain MI Registry were undertaken in 18 international hospitals, most located in developing countries unfamiliar with quality improvement metrics. Results: Of 4,092 patients enrolled, complete data were available in 3,914 consecutive STEMIs included here: 80.5% male; 35.5% smokers; shock on arrival in 10%; and 5.1% with cardiac arrest before intervention. Overall, a 2% improvement on combined endpoints (shock; arrest before or after intervention; final ejection fraction <40%; survival at discharge) was observed over time, and survivorship also increased by 2% (P = 0.003). First medical contact to device time <90 minutes occurred in 74.8%; reperfusion therapy in 94.2%; and adherence to guidelines in 91.8%. Conclusions: This global contemporary registry successfully enrolled STEMI patients in nations generally unfamiliar with quality improvement metrics; trends of improvement in their care were observed. GHATI may facilitate implementation of policies aimed at enhancing outcomes of cardiovascular disease worldwide, particularly in countries with evolving economies.

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