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Treatment of ACS in Russia: Problems and Nearest Perspectives

Treatment of ACS in Russia: Problems and Nearest Perspectives. Evgeny Merkulov , MD, PhD Russian Cardiology Research Center Moscow. There is nothing more flexible than Russian statistics. ACS treatment problems. Huge territory and lack of PCI centers Traffic congestion

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Treatment of ACS in Russia: Problems and Nearest Perspectives

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  1. Treatment of ACS in Russia: Problems and Nearest Perspectives EvgenyMerkulov, MD, PhD Russian Cardiology Research Center Moscow

  2. There is nothing more flexible than Russian statistics

  3. ACS treatmentproblems • Huge territory and lack of PCI centers • Traffic congestion • CVD population’s low awareness • Low quality of life • Late calls for medical aid • High tobacco consumption

  4. Russian ACS registries National ACS Registry (n=139 882) ACS Registry Tomsk (n=13615) till 1998 RECORD Registry (n=796) 18 hospitals 10 cities RECORD 2 Registry (n=1656) 7 hospitals 7 cities ACS Registry Novosibirsk (n=25 635) ACS Registry Krasnodar (n=776) ACS Registry Yakutsk (n=799) till 2008 Mazur N.A. et al. (n=462) till 1974 Beyond 1984 1971 2008 2009 1977 2004 2007 years

  5. Mortality from AMI in 2008-2012 in the Russian Federation % First acute MI – 13,4% Recurrent AMI - 25% years National ACS registry

  6. Peculiarities of ACS mortality in the Russian Federation • Prevalence among able-bodied men • Increase in mortality from AMI among the elderly age women • Elevation in mortality from recurrent AMI • High hospital mortality (15-16%) especially during the 24 hours after hospital admission (40,4%).

  7. Average Time for Cardiovascular Care in STEMI patients min National ACS registry

  8. Reperfusion Therapy • Percutaneous coronary intervention • Thrombolytic therapy

  9. Revascularisation in AMI Widimsky P, Eur Heart J. 2010;31(8):943-57; Prof.James G. Jollis; Cardiovascular Emergencies, 2011 National ACS registry, 2011

  10. PCI per each 1 000 000:Russia 531, Europe 1871, USA 2322 Widimsky P, Eur Heart J. 2010;31(8):943-57; Prof.James G. Jollis; Cardiovascular Emergencies, 2011 National ACS registry, 2011

  11. Frequency of PrehospitalThrombolysis in STEMI Patients %pts 27 26.8 25.4 25.3 22.5 2009 2010 2011 2012 2013

  12. There is an increase of frequency of reperfusion therapy (both thrombolysis and PCI) in STEMI patients from 44.5% in 2009 to 58.5 % in 2012

  13. Vascular Program(launched in 2009)

  14. The main goals of the Vascular Program • Widespread of PCI in emergency conditions • Reducing time of patient’s decision to call emergency • Improving quality and decreasing time of emergency medical care (EMC) • Organizational solutions aimed at improving the EMC effectiveness • Implementation of diagnostics and treatment high-tech methods in the intensive care unit

  15. 52 regions of the Russian Federation are involved in the Vascular Program (out of 83)

  16. There are 189 centers of endovascular diagnostics and treatment with 935 professionals and 334 catheterization laboratories 2013

  17. Frequency of PCI in ACS Patientsin PCI centers % pts • Frequency of PCI in 2013 in STEMI patientsincreased by 4,8% and by 3,1% in non STEMI patients 73,3 % -primary PCI

  18. Russian Cardiology Research Center, Moscow 400 patients in 8 specialized cardiology departments 5 catheterisation laboratories 3500 PCI

  19. Our experience

  20. Initiatives to Improve ACS in Russian Federation Stent for life: regional pharmaco-invasive strategy ESC 2012, Munich

  21. Conclusion In spite of the current problems we face in Russia we hope that taken efforts will improve treatment of ACS significantly in the nearest future

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