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2011 Survey on Reperfusion on STEMI in Europe

Survey on reperfusion therapy for ST-elevation
myocardial infarction in the ESC membership
countries.

When the Stent for Life initiative started 3 years ago one of the first
tasks was to collect data on the use of reperfusion therapy in Europe.
The first survey published by Petr Widimsky et al in the European
Heart Journal revealed a huge variation in reperfusion therapy in the
participating 30 ESC membership countries.
With the help of the National Society Country's champions and contact
persons we are now collecting data on reperfusion therapy in 2011 as
Steen D. Kristensen well as on time delay in more than 30 countries. The deadline for providing data for the next survey is January 15, 2012. In a few countries there are high quality registries on ACS and the use of primary PCI, but unfortunately this is not the case in the majority of Europe. We have asked our contact persons to provide their expert estimates on reperfusion parameters throughout these countries. In the first survey the data was collected in the same way, and the questions were also identical. However, this time we have added some more questions on patient and system delay, which is clearly an important focus area for improvement of STEMI reperfusion therapy. We are looking forward to receive country data not later then on January 15, 2012.We intend to submit the paper to the European Heart Journal and hope that we will be able to present the data at the ESC Congress in 2012. Steen Dalby Kristensen, MD, DMSc, FESC [email protected]

ACT NOW.SAVE A LIFE campaign launched in Bulgaria

The national awareness campaign was
announced as a strong tool for
educating the society and for saving
patients with myocardial infarction.

The nationwide educational campaign called "Act
now! Save a Life!" was launched in Bulgaria with the
aim to make people realize that through being
active and educated they can save their own life or
the lives of their loved ones. The key messages for
the people of Bulgaria are focused on recognizing the signs of a heart attack, quickly calling emergency
medical services and expressing their demand for interventional treatment at the nearest Cath lab. This
was announced on the official press-conference held at the Ministry of Health in Bulgaria on World Heart
Day – 29 September 2011.
The campaign is part of a broad European program for decreasing heart attack mortality rate by
numerous measures including the "Act Now! Save a Life!" educational campaign. In Bulgaria, it was
initiated by the Society of Interventional Cardiology and the Society of Cardiologists with the support of
the Ministry of Health. The utmost aim of the invasive specialists is to increase the knowledge of
cardiovascular disease symptoms and to improve treatment access for patients with infarction through
pPCI procedures.
"Approximately 60% of the total mortality in our country is caused by acute cardiovascular events – heart
attack, stroke and aortic dissection", says Assoc. Prof. Julia Jorgova – National champion for the "Stent
for Life" program, under whose umbrella began the broad national information campaign "Act now! Save
a life" in Bulgaria. She adds that mostly older people over age of 70 are affected, but that in recent years
a frightening trend of heart attack or stroke victims' decreasing age has been noted.
"Myocardial infarction is an acute cardiovascular condition, the symptoms of which are extremely
important to be recognized in time," says Assoc. Prof. Diana Trendafilova – Chairman of the Bulgarian
Interventional Cardiology Society. "The most striking symptoms are acute chest pain moving to the left
arm, neck or jaw, shortness of breath, cold sweat, faintness, panic and fear," adds Assoc. Prof.
Trendafilova.
"The main risk factors that lead to cardiovascular disease are high blood pressure, diabetes, obesity,
stress, smoking, immobilization and passive lifestyle," informs Assoc. Prof. Ivo Petrov – President Elect of
the Bulgarian Society of Cardiology. To preserve their health, the Bulgarians must carry out regular
check-ups with a cardiologist and undergo laboratory tests of blood glucose and lipid profile, recommends
Assoc. Prof. Petrov. He again emphasizes the importance of a timely response to the first symptoms of a
heart attack. In countries where

ACT NOW.SAVE A LIFE campaign launched in Bulgaria
primary angioplasty is implemented as a national program, there is a popular expression "Time is myocardium," which he has expanded into "Time of reaction means saved lives". Through an extensive publicity campaign cardiologists strive to reach every family and urge people to be more active and responsible for the health of their relatives as well as their own. The main objectives of the initiative are: • Increasing public awareness of early heart attack symptoms • Acting quickly and calling 112 for emergency medical response • Receiving appropriate treatment (benefits of p-PCI) The message will reach the population through various communication channels – TV, radio, newspapers and billboards, brochure distribution in the GP and out-patient practices, posters and a special website: www.spasijivot.com. Kiril Karamfilov SFL Project Manager Bulgaria

SFL Portugal launched public campaign to GALP Energia

Public awareness campaign started in September,
in a partnership with the Portuguese oil company, GALP
Energia, in a pilot campaign.
Portugal joined the initiative in February 2011 and has since then created a
Task Force that involves people from EMS, Hospitals and industry partners. It
is a multidisciplinary team with members from different areas: interventional
cardiology, communication, business, marketing and sales.
The strategy of SFL Portugal focuses on two main areas of intervention: faster pre-hospital patient
transport, which will reduce pain-to-balloon time delay and public awareness of MI symptoms and the
need to act quickly and call the emergency number: 112.
Regarding pre-hospital transportation a simpler and more efficient communication process after the
emergency call is being implemented, in order to reduce the patient's pain to balloon time.
EMS Ambulances are being equipped with an ECG that is sent by tele-transmission to the cath-lab.
The public awareness campaign started on 16 September, in partnership with the Portuguese oil company GALP Energia with a pilot campaign. In the first phase an effective awareness programme was launched and to keep the costs as low as possible we agreed on using the company's intranet, the website of Galp Energia and internal newsletters and company meetings. A second phase is being prepared to address GALP customers at gas stations throughout those regions where the STEMI network is functioning with leaflets containing awareness messages. To follow-up the outcome of these two areas of intervention of Stent for Life we have launched a survey called Moment Zero. The analysis of the results was presented at the Annual Meeting of the Portuguese Association of Interventional Cardiology (APIC) on 22 October and shows that only 29% of STEMI patients call 112 and only 12% arrive at the hospital via EMS. The survey also showed that 56% of STEMI patients were at a non P-PCI centre before being sent to a P-PCI centre. Half of these patients lose more than two hours while being transferred to a P-PCI centre. The results of this Survey will allow us to establish a baseline and monitor the impact of the Stent for Life Initiative over three years and confirm the right strategy to improve those indicators. Sofia de Mello, SFL Project Manager Portugal Ukrainian Association of Interventional
Cardiologists became the first SFL Affilite organization

The Ukrainian Association has been
endorsed by the SFL Executive Committee
and became a Stent for Life Affiliate
organization. Prof. Miodrag Ostojic, SFL
Eastern European leader, shared his
experience of the SFL Initiative
implementation in Serbia and welcomed
the new addition to the SFL team.

The Ukrainian Association of Interventional Cardiologists was founded at the National Congress of
Cardiology in Kiev on 21 September 2011. As Prof. Yuri Sokolov, the Head of the Association says: "The
main purpose of the Association is to reduce the burden of cardiovascular diseases through effective
development of interventional cardiology in Ukraine and to protect the legitimate social, economic and
cultural rights and as well as other interests of the Association's members.
The main tasks of the Association are:
Promoting and bettering the organization of cardiac care in the interventional diagnosis field and improving the treatment of patients with acute coronary syndromes and symptoms of chronic ischemic heart disease; Facilitating the creation of "Reperfusion Centers" in all regions of the country for patients with acute myocardial infarction (AMI); Maintaining the Ukrainian PCI Registry created more than year ago, which is set to help show the real contribution of intervention in cardiovascular disease treatment, particularly concerning patients with acute coronary syndromes, and to determine the dynamics of interventional cardiology development in Ukraine; Promoting and improving the educational system in the field of interventional cardiology, leading to certification of new Interventional Cardiology Centers throughout the country; Establishing an effective dialogue between the Association's members and government officials on issues related to guaranteeing the Ukrainian population an effective and timely access to specialized cardiac care; Interacting with the European Society of Cardiology (ESC) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) and other international associations active in the field of interventional cardiology; The Ukrainian Association of Interventional Cardiologists became the first SFL Affiliate organization in October 2011. Ukrainian Association of Interventional Cardiologists
became the first SFL Affilite organization

The Ukrainian Association has been endorsed by the SFL Executive Committee
and became a Stent for Life Affiliate organization.

The SFL Symposium was organized on 22 September 2011 and the press conference was covered in
national television and by a number of important journalists. Prof.Miodrag Ostojic, SFL Country Champion
Serbia and SFL Eastern European leader shared his experience of the SFL Initiative implementation in
Serbia and welcomed the new addition to the SFL team, Maxim Sokolov, who will coordinate the SFL
Initiative implementation in Ukraine.
SFL affiliates are independent groups and organizations, which share similar aims and objectives of the
Stent for Life Initiative. Affiliation is free and there are only a few guidelines that groups must comply with.
The groups remain independent yet profit from the partnership created.
Dr. Zuzana Kaifoszová
SFL Europe Project Manager
How to become affiliated with SFL Initiative

Information for new applicants
If you are interested in becoming an SFL Affiliate you have to:
Fully comply with the Aims & Objectives of the Stent for Life Initiative as approved by the SFL Executive Committee (www.stentforlife.com); Have a governing document outlining your aims & objectives; Ensure that the SFL country organization is set up in partnership with the National Society of Cardiology and/or Interventional Cardiology. Apply for SFL Affiliate status by submitting a letter of application to Dr. Zuzana Kaifoszova, SFL Initiative Project Manager, Europe at [email protected]. SFL Italy: Quality data as a background for the right decision

The development of an "ideal" system for STEMI
identification, quality of care processes and performance
measurement is a big challenge for the Italian team.
Quality of care in ST-elevation myocardial infarction (STEMI) has become an
important focus for physicians, hospitals, payers, and medical organizations.
However, the development of an "ideal" system for STEMI identification, quality
of care processes, and performance measurement is challenging. Theoretically,
all STEMI patients should be included in process measurement: patients who
undergo PCI; patients who undergo coronary artery bypass grafting or are
managed medically; false-positive cardiac catheterization laboratory activations;
patients who receive fibrinolytics and are transferred to a rescue PCI center; patients who receive
fibrinolytics but remain at a non-PCI center; and eligible but untreated patients who have received neither
fibrinolytics nor PCI. Important time for treatment measures beyond door-to-balloon time (eg, chest pain
onset to first medical contact, first medical contact to hospital arrival, hospital arrival to ECG, in-door/out-
door at a community hospital, transfer time, chest pain onset to balloon/needle) and outcome measures
(adjunctive medication use, bleeding, recurrent ischemia, recurrent revascularization, stroke, myocardial
infarction, mortality) would also be tracked. Finally, a single comprehensive data collection system would
include the economic and human resource burden of multiple quality assurance programs.
In our SFL program, in order to promote and implement regional protocols according to the specific local
constraints, we plan to monitor their effectiveness by recording simple quality indicators in ongoing
registries. In addition, we are going to conduct a survey on health costs of STEMI reperfusion in a target
region (Sicily) immediately before and 1 year after the development of a STEMI network, in collaboration
with the University Bocconi of Milan (Cergas). Finally, a new 3 month data collection of the entire Italian
STEMI network system (II Edition of the Rete IMA web registry) will re-start soon after the software
update, in strict cooperation with the Italian emergency medical system. The first edition of the "RETE
IMA web" survey was launched in 2007 from GISE in collaboration with the Italian Federation of
Cardiology, with the aim of evaluating the current state of regional care systems for STEMI in Italy. Data
collection was done using different electronic forms with access limited by personal passwords. The
survey assessed the organization of regional care systems together with the local resource availability,
with specific attention to the distance from a Hub center. The survey ended in December 31, 2008 and
featured a total of 701 hospitals admitting STEMI patients, 157 (22.4%) with uninterrupted access (h24/7
days) to the catheterization laboratory (2.67 per million inhabitants). An operative network was present in
36/103 (35.9%) provinces, with important geographic variability. Among hospitals without a full-time p-PCI
facility, only 46% were within a regional system of care. ECG was available in 72% of the national
territory, telemedicine in 50%. Pre-hospital fibrinolysis was available in 16% of the country. Overall, 92.4%
of the Italian population resides within 60 minutes of a Hub center, suggesting that the lack of STEMI
networks is not related to the need of infrastructures such as cath labs or coronary care units, but it is
linked rather more to organizational and political issues. This data was the perfect background for
selecting the target regions and starting the SFL project in Italy.
Leonardo De Luca
SFL Project Manager Italy
Web based registry in Bulgaria


A special electronic register of invasive cardiology interventions performed in
every hospital was launched on November 1.
As a result of the active collaboration between the Bulgarian Ministry of Health and the invasive
cardiologists an official register will be launched on 1 November – a special electronic register of invasive
cardiology interventions performed in every hospital. The web based registry is designed to increase
control over these activities in the country and thus ensure better quality service and patient safety (6000
Bulgarians die annually due to heart attacks).
The registry will be maintained by the National Center for Public Health and Analysis. Information will be
entered in 36 general hospitals with invasive cardiology departments. Each doctor will have an electronic
signature, password and name input in the system in order to enter any invasive interventions performed
and the patients' details.
"This registry is a result of the collaboration between the Ministry of Health, the cardiologists and the
patients", claimed Dr. Stefan Konstantinov, the Minister of Health in Bulgaria during the press-conference.
He also added that the registry will store information on behalf of the treating specialists, the patients'
data, type of procedure – emergency or planned, diagnostic or therapeutic, the beginning and end of the
intervention and its indications.
Kiril Karamfilov, SFL Project Manager Bulgaria
SFL Bulgaria presents SFL progress at
a national interventional cardiology congress

A special session named "Stent for Life" was organized during the Annual
Bulgarian Invasive Cardiology Congress that took place on 7-9 October 2011 in
Sofia.

A special session named "Stent for Life" was organized during the Annual Bulgarian Invasive Cardiology
Congress that took place on 7-9 October 2011 in Sofia. It was designed to accumulate the efforts of all
interventional cardiologists in order to provide a holistic approach to patient education, access to
specialized treatment and their follow-up. The European Stent for Life headquarters sent a special
speaker to the congress – Prof. Steen Kristensen – Stent for Life Co-Chairman. He emphasized the
significance of the pilot project in Bulgaria and informed the cardiological society of the initiatives for
decreasing mortality and complication rates after myocardial infarction throughout the European Union.
He thoroughly expressed his high hopes in the campaign held in Bulgaria in front of the media.
Kiril Karamfilov, SFL Project Manager Bulgaria
How SFL Romania celebrated World Heart Day
Outdoor events and press conferences in Buchurest and Sinaia were organised with the main objective: to increase awareness of cardiovascular disease prevention, asses the risks of cardiovascular diseases. The main objective of this year's World Heart Day in Romania, celebrated on the same day as the 50th National Congress of Cardiology was to increase awareness of cardiovascular disease prevention, asses the risks of cardiovascular diseases in the country and first and foremost promote important changes in lifestyle and attitude such as healthy diets, stopping to smoke and exercising daily amongst the general public. In this context, outdoor events and press conferences organized by the Romanian Heart Foundation were held in Bucharest(24 September 2011) and Sinaia (29 September 2011). The press conferences featured such speakers as Professor Dr. Dan Gaita – President of the Romanian Heart Foundation, Dr. Dan Deleanu – President of the Romanian Society of Cardiology, Professor Dr. Dragos Vinereanu- Chief of Cardiology Commission in the Ministry of Health, Dr Rodica Tanasescu –President of GP' National Society, Conf. Dr. Ioan Mircea Coman – Future President of the Romanian Society of Cardiology and Dr. Radu Rasinar from GM AstraZeneca – Sponsor of the event, all of whom support and take part in the "World Heart Day events". The Romanian Heart Foundation also set up four areas dedicated to cardiovascular risk disease assessment in each of the cities (assessing over 800 people) and organized a number of flash-mobs and "Ride for your Heart" competitions to get the most out of the public's attention. Over 50 representatives of the media and press attended and covered these events as well as the following TV stations: ProTV, Antena1, Antena3, TVR, TVRM, Prima TV, B1TV and Health TV. Ileana Penea SFL Project Manager Romania SFL Greece: Crisis as an opportunity to lead a change
SFL Greece is trying to make the best out of a truly problematic situation and promote the goals of Stent for Life in every way possible. In the last couple of years, Greece has entered a difficult period on an economic, social and political level. This has been a major challenge for Stent for Life Initiative (SFL) implementation in the country, since funds are extremely limited and the uncertainty of tomorrow is overshadowing all aspects of life. Despite these difficulties, SFL Greece is trying to make the best out of a truly problematic situation and promote the goals of Stent for Life in every way possible. An SFL National Project Manager was appointed to support the Initiative. Lina Hourdaki is closely working with Dr. John Kanakakis to accelerate the project's execution. Dr. Kanakakis says: "SFL Greece has successfully organized the PPCI hospital network in Attica and in Southwestern Greece and we are constantly informing physicians and hospitals about the importance and objectives of Stent for Life. As a result the PPCI rate has risen from 8% in 2008 to 20% country wide. The most significant regional increase has been achieved in Attica, representing almost 50% of the total population, with an increase of 40%. In the spring of 2011, a milestone year for Greece, Stent for Life launched the national ACS registry. A web based questionnaire was developed for easier and quicker access for all physicians and hospitals. The registry's aim is to keep record of all the cases of patients with ACS in Greece in order to collect the data on their treatment, monitor the system delays as well as the progress made each year. In September 2011, the SFL Task Force Greece was also formed. This is a major step to expand the PPCI hospital network in Crete, Thesaloniki and Thrace. As we pointed out the overall situation in Greece is not easy right now but we are determined to find opportunities and not only focus on threats. Changes can be made and progress is feasible as long as we continue to work together towards our goals. We remain very optimistic for the Stent for Life initiative as our Society has shown that it is eager to keep on moving forward. We believe that through our energy and enthusiasm we can ensure that the majority of ACS patients will soon have access to life saving treatment in Greece. Lina Hourdaki SFL Project Manager Greece SFL Spain is launching SFL Supplement at
Revista Espagnola de Cardiologia


SFL Suplement of the official journal of the
Spanish Society of Cardiology was introduced
during the annual congress at Gran Canaria on
20 October 2011.

SFL Spain and the Spanish Society of Cardiology released the
Stent for Life Supplement of the Revista Espaňola Cardiologia,
the official Spanish Society of Cardiology journal, during the
annual congress at Gran Canaria on 20 October 2011. The SFL Country Champion Dr. Manel Sabate
and SFL Project Manager Spain Dr.Matias Feldman together with Dr. Magda Heras, Editor in Chief
introduced the SFL Supplement to media during the main press conference of the congress. The SFL
Supplement introduces the SFL Initiative in Europe and describes its objectives and achievements in
Spain. Detailed models of PPCI networks in six communities in Spain Navarra, Murcia, Islas Baleares,
Galicia, Cataluña and Castilla-la Mancha are also included. You can learn more at
www.revespcardiol.org.
SFL Spain & Women at the Innovation Symposium

The seriousness of cardiovascular disease (CVD) amongst women was highlighted at the SFL & WIN
symposium organized during the SEC 2011 conference. Fina Mauri, former SFL Country Champion of
Spain and WIN representative in Europe and Manel Sabate, current SFL Country Champion chaired the
session.
Currently, CVD is responsible for the death of more than 65,000 women a year in Spain, as shown by the
records of the INE (National Statistics Institute) from 2009, published in July 2011, already surpassing a
7.66% of male deaths from the same causeor this reason. CVD, then, is positioned as the leading cause
of death among Spanish females, with 35.10% of all deaths.
Cardiovascular diseases have different incidence, outcome and prognosis in the population depending on
sex, but until recently, neither the society nor the doctors have taken these differences, significantly
hurting the women.
The symposium highlighted the need to increase the number of women patients in clinical trials based on
the fact that only 33 % of patients in the 62 randomized clinical trials published between 2006 and mid
2009, which enrolled 380 891 participants were women. Clinical trials enrolling a significant number of
women to allow for pre-specified gender analysis should be encouraged.
The symposium proved that there is need to find out what are the barriers restraining access to early
diagnosis and treatment of acute coronary syndrome for women. The SFL Initiative and WIN will review
this imperative issue and recommend a strategy on how to address it, said Zuzana Kaifoszova, SFL
Europe Project Manager.
Matias Feldman
SFL Project Manager Spain
Medtech Forum 2011

Medtech Forum 2011 confirmed the need for all stakeholders to work together to ensure
that patients have equal access to innovation.

On 12 October 2011, Eucomed, the European medical technology industry association, launched the five-
year strategy for the European medical technology industry at its annual event, the MedTech Forum. The
five-year strategy ‘Contract for a Healthy Future' explains the commitment of the European medical
technology industry in steering European healthcare systems onto a sustainable path. The medical
technology industry acknowledges that it needs to change and will embrace, deliver and demonstrate
cost-efficiency and health outcome needs of payers and policymakers, which is the essence of value-
based innovation. The industry commits to playing its part and providing medical technology innovations
that ensure sustainable, accessible healthcare and healthy ageing. In turn, it requests that other
stakeholders play their role too. With this Contract, Eucomed appeals to other healthcare stakeholders to
also reconsider their role as the industry cannot achieve a healthy future for Europe on its own.
What healthcare professionals can do, e.g.
See technology as an enabler of change; Embrace the power of patients and other stakeholders in health-decision making.
The ‘Contract for a Healthy Future' and the Economist Intelligence Unit report ‘Future-proofing Western
Europe's healthcare' as well as related videos, interviews and animations can be downloaded and viewed
on www.reforminghealthcare.eu
Dr. Zuzana Kaifoszová
SFL Europe Project Manager
Book your calendar for SFL FORUM Meeting

SFL FORUM meeting will be organized on 1-2 March 2012 in Prague. You can learn more about how to
implement the SFL Initiative in your country.
More information about the SFL FORUM meeting program and call for abstracts will be available at
www.stentforlife.com soon.
SFL Session at Alpe Adria Association Congress

Central and Eastern European Interventional cardiologists shared best practices on how
to build an effective PPCI networks at Alpe Adria Association Congress.

The 19th International Meeting of the Alpe Adria Association of Cardiology was held in Budapest between
15. and 17. September. The traditional circle of the participating countries of the Alpe Adria Meetings had
been extended and therefore this year's 300 registered participants arrived from 21 European countries.
This expansion of the circle of participating countries happened in order to raise the public awareness of
myocardial infarction. Therefore, the organizers dedicated an eighty-minute long session to the "Stent for
Life" Initiative where the leading cardiology experts of Czech Republic, Hungary, Romania and Serbia
spoke about their experiences.
Dr. Dan Deleanu
Dr. Dan Deleanu, the President of the Romanian Society of Cardiology, spoke about their first experience with SFL in Romania. He said that before launching the program the major problems in Roman ia were the lack of PCI STEMI networks in the country, the bad reimbursement for PCI procedures, the low number of cath labs (24/7cath labs), the small number of trained interventional cardiologists and in general, the lack of public awareness of AMI and of importance of time. As Dr. Deleanu stressed, they started the "Stent for Life" program in August 2010 in 5 regions in the country with about 40 pPCI/mil and a mortality of about 12% and they would finish it this year, in 2011 with about 200 pPCI/mil (about 4000 pPCI/year). All the patients from the regions included in the program have been treated by pPCI – in the Bucharest area they already have about 600 pPCI/mil, instead of thrombolysis and the mortality has decreased a lot. Dr. Deleanu evaluated their first year as a good start. As he explained, their STEMI Registry already holds more than 20 000 patients and they managed to get financing for 3500 cases of pPCI in STEMI in the first year and the treatments executed since 2000 have overall rapidly increased. On the other hand, they set as their target that until 2014 they would like to double the number of cath labs in Romania and make the treatment of AMI possible in 14 centres across the country. The President of the Romanian Society of Cardiology also noted that a public mass-media campaign was going to be launched in Romania in October 2011 in order to increase public awareness about STEMI.
SFL Session at Alpe Adria Association Congress
Dr. Petr Kala
Dr. Petr Kala, Ambassador of the "Stent for Life" Initiative, spoke about the current status of the initiative in his lecture. As he said, Stent for Life (SFL) was one of the clinically most important activities of the European Association of PCI (EAPCI) supported by the European Society of Cardiology (ESC) and its Working Group of Acute Cardiac Care. The aim of the project was to improve the delivery and patient access to the life saving indications of PCI, thereby reducing the mortality and morbidity of patients suffering from acute coronary syndromes. It very well fulfilled the mission of ESC „to reduce the burden of cardiovascular disease in Europe,"and helped to acquire ESC practical guidelines for daily practice. Dr. Kala divided the activity of SFL into three steps. As he pointed out, step number one had described the current practice of treatment of patients with acute myocardial infarction in Europe. Several important results had been observed like nearly a 50% reduction in mortality in favor of primary PCI. Probably the most exciting finding had been the so-called reperfusion paradox. This had been explained as the wrong expectation of good care in countries with more pronounced thrombolytic therapy but the best care had been provided in countries with a very well developer primary PCI (pPCI) program. The results had been published online in EHJ 2009. Step number two and three had followed this observation closely and had collected the best reference countries´ experience and its implementation in selected countries or regions. Six pilot countries had been involved in the SFL Initiative in 2009 and another four countries had signed the collaboration in 2010-2011. Large countries like France and Turkey had selected just some of their regions to take part in the program and closely follow the results. The speaker raised the question of what we had learned from this initiative and came to the conclusion that though most of the regions / countries had started from very low absolute numbers of pPCI procedures, the changes were in some cases truly unbelievable. For example, the number of pPCI in Adana, with a population of 2 million in this Turkish region, rose from 83 per million in 2008 to722 in 2009. Dr. Kala highlighted that the current and most challenging activities of SFL were to establish a reporting system showing the progress in all SFL countries and to develop an SFL manual "How to set up SFL Initiative in countries". Besides that it was planned to launch SFL data survey in Europe and to present the results at ESC 2012 and to start the SFL public campaign in 4 SFL countries. As the lecturer added, he was convinced that collaboration, enthusiasm and hard work were all needed to improve the current European practice of AMI treatment. Without being very open the SFL Initiative would never be so successful among countries with huge differences and he was personally sure that this activity should be applied not just in Europe but all over the world. Dr. Kala concluded his lecture by acknowledging the work of all the SFL Initiative participants and their supporters and especially the team responsible for the project – S.D. Kristensen, J. Fajadet, P. Widimsky, C. di Mario and W. Wijns, members of the SFL Executive Committee and SFL project manager Z. Kaifoszova supported by M. de la Torre.
SFL Session at Alpe Adria Association Congress
Professor Béla Merkely
Professor Béla Merkely, the President of the Hungarian Society of Cardiology, also stressed the significance of the "Stent for Life" Initiative. As he said, thanks to the initiative, primary PCI care in Hungary received fresh ammunition. Hungary was a relatively small country with 10 million inhabitants and an average GDP rate. Conversely, the state of development and the accessibility of primary PCI was a good example of the fact that certain very effective healthcare areas could receive higher financial support than the country's economic situation could make it possible. As Professor Merkely highlighted, already in Professor Widimsky's article ("Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries" (EHJ 2009)), Hungary had earned a good position with its 64% primary PCI rate in 2007. Nevertheless, looking at the European map of geographical distribution, Hungary had ranked at the highest category, ≥ 600 pPCI/ 1 million inhabitants /year. As Professor Merkely said, the far less effective thrombolysis was used in less than 1% of AMI's. The rate of use of modern radial approach was high. In the treatment of acute myocardial infarction, not only STEMI, but PCI has a significant and growing importance –it is enough to think about the new non ST-elevation acute coronary syndrome guideline of ESC (2011). Parallel to the growing use of PCI in overall AMI, infarction mortality had unambiguously and gradually decreased. Professor Merkely reflected on the fact that in Central Hungary there has been acute myocardial infarction care since 2003 and it ensured the immediate access of PCI for approximately 3 million inhabitants in a 24/7 system. In the first six years about 12 000 patients had received primary PCI in the frame of this "Budapest model". It was important that more than half of the patients had arrived during duty time. In-hospital mortality was exemplarily low, at 3.5 %. As Professor Merkely added, it was a very fortunate thing that the rate of self-referral STEMI patients arriving directly to cath labs had also been increasing. There was no difference in the short- and long-term mortality of patients treated in working hours and in duty time. As Professor Merkely concluded, due to the development of PCI care, infarction mortality had unequivocally decreased in Hungary, down to a half during ten years. This could be realized only by a permanently accessible acute PCI duty system, according to the vision of Stent for Life. SFL Session at Alpe Adria Association Congress
Professor Miodrag Ostojic

Professor Miodrag Ostojic, the President of the Serbian Heart Foundation, said that since the publication
of "Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current
situation in 30 countries" (EHJ 2009) by Widimsky et al, the European initiative Stent for Life (SFL) had
been launched and then, ten countries with far from optimal reperfusion strategies in STEMI had been
included with prospective follow-up.
As Professor Ostojic explained, Serbia had had 48% of pts without any attempt for reperfusion, while 19%
and 33% of pts had been treated by pPCI and hospital thrombolysis in 2008, respectively. Impressive
improvement had been registered in 2009, with 37.5% of pts without reperfusion, while 34.2% and 28.3%
of pts had been treated by pPCI and hospital thrombolysis, respectively (9 centers, 18 Cath Labs).
Further progress in 2010 and 2011 had been observed with 492 pts/1 mil.inhab./year predicted for 2011.
However, the aim of 600 pts/1 mil. inhab./year had been achieved in Belgrade(711 pts/1 mil. inhab./year).
As the two new centers were planned to be opened in the central and Southern-East Serbia in 2011,
there were good prospects for S4L to reach across the whole Serbia.
Professor Ostojic concluded that the time had come to focus not so much on quantity (numbers/mil./year)
but on quality (improving the pr administration of Aspirin and Clopidogrel as well as shortening system
delay in transfer of pts to Cath. Lab.). Comparison of FMC to balloon time in Serbia vs. West of Denmark
STEMI registry had shown that Serbia ran on a trajectory of 131-180 min system delay which had pretty
high late mortality. Also, under ideal conditions about 1 million people could not reach a cath lab within 90
min due to a non-adequate geographical distribution of cath labs. This was a good reason to practice
prehospital (or hospital) thrombolysis within 30 min of the first medical contact provided that within 24 h
coronary angiography would be performed or earlier in the case of rescue PCI. The emphasis has been
put on shortening system delay as well as increased use of Aspirin and Clopidogrel by EMS by using
reperfusion list as well as to start prehospital thrombolysis if the cath lab may not be reached in due time.
Prof. Béla Merkely
Béla Merkely1, Dan Deleanu2, Petr Kala3, Miodrag Ostojic4,Dávid Becker5
1Director,SemmelweisUniversityHeartCenter,Budapest,Hungary
2Department Head, Department of Invasive Cardiology, Cardiovascular Diseases Institute C.C.Iliescu", Bucharest, Romania
3Head of the Acute and Interventional Program, University Hospital Brno, Czech Republic
4 Head, Division of Cardiology, Clinical Center of Serbia, Serbia
5DeputyDirector, Semmelweis University Heart Center, Budapest, Hungary

Interview with SFL Ambassador Petr Kala

Interview with Ass. Prof. Petr Kala, MD, PhD, FESC
SFL Ambassador Vice-Chair of the Czech
Interventional Cardiology Working Group
Member of EAPCI Scientific Program Committee and
Databases & Registries Committees
SFL Initiative is supported by key interventional cardiologists
from many countries where STEMI networks are well established
and majority of ACS patients have access to the life saving
indication of primary PCI. One of them is Petr Kala, Ass. Prof. at Medical Faculty Masaryk University in
Brno, Czech Republic, member of EAPCI Committees. Petr has been supporting the SFL Initiative
implementation from its beginning in 2009 giving presentations at different conferences and sharing his
exceptional practice experience with the audiences.

Why have you agreed to become an SFL Ambassador?
For me there were several reasons to take part in the SFL Initiative. The most important and clinically
relevant was the extreme strength of the idea. Besides that I wanted to share my experience with building
the primary PCI program in my own country that serves as one of the good examples of AMI care
systems. It is important to show the complexity of the problem but to be more practical I would like to help
my colleagues to find the fastest and most effective way of fulfilling the primary goal of SFL. A little bit
more hidden, especially if we are talking about politicians´ views is the fact that the primary PCI does not
"just" save lives but has probably the highest positive socio-economic impact in modern medicine.
Simpler said, I love cardiology and I would like to help in increasing the luck of the AMI patients and
interventional teams.

What was the most rewarding experience during those two years you've been supporting the SFL
Initiative?
It is always very exciting to see the differences among countries that can be changed by a relatively
simple but a very strong idea. Without great enthusiasm, open communication and collaboration of all the
people involved in the project this could never become true. Every beginning is difficult but the initiative
offers a new insight into the practice and shows the right path and successfully opens minds.

According to your opinion, what has been the most common barrier in all the countries when
building the PPCI network?
We can talk about the clinical and economical barriers. From the clinical point of view the Network and
infrastructure and the Emergency Medical System (EMS) are the main topics. Regional network that
should cover a 0.3-1.0 million population (optimally around 0.5) contains EMS, 24/7 PCI centers and also
the non-PCI hospitals. All these partners have to realize the global profit for the patients and the
healthcare system. Please remember that if we are talking about the EMS, the AMI patients represent just
a very small part of their daily work. So sometimes (mostly) it is quite difficult to get well trained EMS
teams and the ambulances equipped with 12-lead ECG and resuscitation facilities at the end of the day.
Implementing the protocols of critical care pathways is part of the work and the good thing is that this
system can be generally also applied in other serious health conditions like strokes. Regarding the
economy there are needs for quite a big investment in the beginning of the program but as I mentioned
earlier the cost-benefit ratio is of very high value.
In summary without good interdisciplinary collaboration and the investments it is impossible to build a
good system.

Interview with SFL Ambassador Petr Kala

How have you overcome this barrier in your home country?
It was quite a long way to be able to offer the PPCI to the whole population. This activity was physician
driven and very strongly supported by the Czech Society of Cardiology on top of the Prague1-2 trials lead
by P. Widimsky. The national STEMI guidelines recommended the transport to PPCI already in 2002
even earlier than the ESC did. Discussions including presentations in the Parliament, with the Czech
Ministry of Health, other politicians, representatives of insurance companies together with EMS,
community hospitals and public campaigns were needed to start the PPCI as a population program. We
had to open new cathlabs to decrease the transport times and distances. This was possible just under the
condition of providing 24/7 program by at least 3 cardiologists licensed for interventional cardiology by the
Czech Medical Chamber. We had to train the EMS staff and especially we had to brake the routine.
Actually we had to overcome exactly the same barriers like all the countries did, should or are doing right
now.

Recently you gave a talk at the Alpe-Adria meeting, which was part of the SFL symposium. What
were the key take-home messages from the discussion?

I was really pleased to take part in the session together with the colleagues from Hungary and Romania.
The discussion was really interesting with the following important messages:
- There is strong need for the STEMI or even broader ACS national Registries (with the
Scandinavian countries as the best examples)
- We have to follow the quality of our care (PPCI)
- It is possible to build the PPCI program in countries despite their very different geography and
economical background
The results of the PPCI care are so exciting that the principles of the SFL Initiative should be applied not
just in selected countries but all over the world.

Source: http://stentforlife.arakis.cz/wp-content/uploads/2012/01/SFL-Newsletter-Edition-3_v7.pdf