A better coordination of the health system of each autonomous community would save a thousand people each year suffering an acute myocardial infarction (AMI), as explained by experts gathered last Wednesday at a press conference organized by the Spanish Society of Cardiology (SEC) to present the latest developments in the treatment of AMI in Spain.

The most recommended technique for the treatment of acute myocardial infarction, provided that it is performed under the appropriate conditions and quickly, is the primary angioplasty. This technique treats the obstruction of the coronary artery by aspiration of the thrombus and the implantation of a 'stent' (a kind of metal mesh) that resolves the underlying narrowness.

If the health system is well coordinated, from emergency medical systems, hospital and extra-hospital emergency services, coronary and intensive care units, to cardiologists and interventional cardiologists, the patient could arrive in time to be practiced this technique. On the contrary, if this treatment is not available, the infarcted person should be treated with fibrinolysis (intravenous administration of thrombolytics), thus reducing the efficacy by 35%, and increasing the risk of major bleeding.

If the patient manages to be operated on with a primary angioplasty at the appropriate time, his chances of survival are 95%

In this sense, the speed of response is key in the prognosis of this pathology that affects 70,000 Spaniards every year, of which, although 40,000 arrive alive at the hospital, 15% of the latter can not survive. In the words of the president of the SEC, Dr. Carlos Macaya, "time is very important, so at the moment when the individual or relatives believe that it can be a heart attack, for that intense pain, they should take contact with out-of-hospital emergency services to be diagnosed as soon as possible ".

Such is the importance of the time that if the patient manages to be operated on with a primary angioplasty at the appropriate time, his chances of survival are 95%. "If more than 90 or 120 minutes go by, the benefits of angioplasty are lost because all the cells related to the occluded artery will have died and the infarction will have been completed," explains Macaya.

Differences by communities

The doctors have highlighted the enormous variability that exists between the different autonomous communities Spanish hospitals in terms of access to primary angioplasty. In this way, those that already have a healthcare network established for the treatment of IAM, such as Navarra, Murcia, Galicia, Catalonia and the Balearic Islands, have a better response and have managed to carry out, each of them, more than 300 interventions per million inhabitants in the last year, reaching 410 in the case of Navarra. By contrast, the Valencian Community is the community in which fewer angioplasties per million inhabitants were made in 2010, with 122, followed by Asturias, Andalusia and Aragon.

To remedy this variability, cardiologists have presented during the press conference the initiative 'Stent for life', promoted from the European Society of Cardiology (ESC) and supported by the SEC, which aims to give access to primary angioplasty to the greatest number of patients through the implementation of network reperfusion programs for the treatment of acute myocardial infarction.

Experts say that "it is very important that all autonomous communities have a structure that allows patients with AMI to have access to primary angioplasty practiced early, because experience shows (taking the case of Catalonia as an example) that a network reperfusion program can reduce by 5% in absolute value cases of mortality in people who have suffered a heart attack, which would mean, at the state level, 972 lives saved every year".

Despite everything, according to data from the National Registry of Activity in Interventional Cardiology, Spain has increased by 79.2% the number of primary angioplasties performed in the last ten years, from 2,149 in 2000 to 10,339 in 2010.


Coronary Angioplasty Surgery | Balloon Angioplasty | Nucleus Health (November 2019).