Reperfusion therapy for ST elevation acute myocardial infarction in ...

950
P. Widimsky et al.
Figure 2 Primary PCIs per year per million inhabitants in European countries. Grey colour, no data available; blue colour, countries participating
in this study.
TL and p-PCI. Both treatments can certainly be offered more
expeditiously than was shown in this study. This should be one
of the main goals for future improvements.
Primary PCI volume per centre
and per operator
Primary PCI volume per centre and per operator may influence the
outcomes, especially of STEMI patients, where the complexity of
care is more important compared with elective PCI. Unfortunately,
this study was not designed to collect such data. The experience
from countries, using primary PCI for vast majority of their
STEMI patients, shows that a population between 0.3 and 1.1
million per one primary PCI (i.e. non-stop, 24/7) centre results
in ca. 200–800 primary PCI procedures/year/centre. This may be
considered optimal. Population per centre ,0.3 million results in
low numbers of STEMI and thus the experience of the team may
not be sufficient. A population significantly greater than one
million results in ‘overload’ of the centre by too many infarcts
(of course only if all infarcts from that region are admitted to
this centre). The PCI volume per operator is probably less important
than PCI volume per centre, as there are very few low volume
operators in the high volume centres. The optimal case load may
be anywhere between 50–100 primary PCIs/operator/year.
Reimbursement
In most European countries (Austria, Croatia, Czech Republic,
Denmark, Germany, Greece, Hungary, Italy, Israel, Lithuania, the
Netherlands, Norway, Poland, Portugal, Serbia, Slovakia, Slovenia,
Sweden, and Switzerland), the reimbursement systems supports
primary PCI—i.e. the PCI hospital is reimbursed adequately, the
non-PCI hospital in general does not lose money by sending
patients for primary PCI and Emergency Medical Services (EMS)
transfers are reimbursed. In some countries, PCI centres
receive reimbursement for primary PCIs, but the small hospitals
lose money when STEMI patients are admitted initially to PCI
centres (Belgium, Bulgaria, Spain, Turkey, and UK) or interhospital
transfer is not appropriately reimbursed (Belgium and Bulgaria). In
only one country (Romania), PCIs (any) are not adequately reimbursed
in general (low limits on numbers of centres and
procedures).
Barriers for the implementation
of primary PCI in Europe
Reimbursement is only rarely a real problem (see above). EMS
interhospital transport is not supported by adequate reimbursement
in some countries, and in smaller districts only a single
EMS ambulance is in service during the off-hours and cannot go
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