الفهرس 
Acute Myocardial InfarctionOnly 14 pages are availabe for public view
Abstract
worldwide, coronary artery disease (CAD) is the single most frequent cause of death. Over seven million people every year die from CAD, accounting for 12.8% of all deaths. The in-hospital mortality of STEMI patients in the national registries of the European society of cardiology (ESC) countries varies between 6% and 14% (Steg et al., 2012).
Primary PCI, defined as percutaneous catheter intervention has replaced fibrinolysis in patients with STEMI, in settings where primary PCI cannot be performed in a timely fashion, fibrinolysis should be administered as soon as possible.
The aim of the present study was to assess and evaluate the current management protocol of patients admitted with acute STEMI and the clinical outcomes before discharge and after 6 months.
This is a cross sectional observational study that included a random sample of all STEMI patients admitted at East Cairo Province hospitals. A total number of 281 patients were then categorized into three groups:
group A: 153 patients (54.4%), STEMI patients who arrived at a primary PCI capable center.
group B: 88 patients (31.3%), STEMI patients who arrived to a non- primary PCI capable centers and were not transferred.
group C: 40 patients (14.2%), STEMI patients who arrived to common hospitals and transferred to PCI-capable hospitals (Ain Shams University Hospitals)
The mean age of the current study population was 56.88 ± 12.81 years ranging from 21 to 90 years. In this study Men represented 73% of all patients, 53.4% of all patients were smokers and 52% were diabetic. The median for Patient delay was 6 hours and the median for system delay was 40 minutes. The maximum system delay was found among group C, followed by group B then the least time delay was found among group A.
It was notable in our study that 247 patients (88%) arrived to the hospital of FMC on their own while only 34 patients (12%) called the emergency system.
In the present work, the initial reperfusion therapy was primary PCI in 58.7% of patients, Streptokinase in 39.5% of patients, and no reperfusion in 1.8% compared to 85.42%, 7.26% and 7.32% for EU countries. The in-hospital Mortality was highest among patients with Killip IV (33.6%) followed by Killip III (12.5%).
Follow up data during the hospital stay included different components of MACCE; bleeding, re-infarction, cardiogenic shock, stroke and mechanical complications as well as in-hospital mortality.
Patients who arrived at a PCI-capable center and were treated by a primary PCI had significant reduction in MACCE and all cause mortality during their hospital stay compared to those who received thrombolysis at a non-PCI capable center.
Follow up data at 6 months included bleeding, re-infarction, Angina or HF requiring re-hospitalisation, stroke and all cause mortality.
Patients who arrived at PCI-capable center and were treated by a primary PCI had significant reduction in re-infarction, Angina and HF requiring re-hospitalisation and all cause mortality compared to those who arrived at a non-PCI capable center and received thrombolysis and those who were transferred from a non-PCI to a PCI-capable center for the purpose of a primary PCI.