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The Stent – Save a Life initiative is designed “to improve for patients with ST- segment elevation myocardial infarction the access to guideline-coherent therapy and to primary percutaneous coronary intervention, because we believe that this is finally the best treatment,” explained Christoph Naber, one of the chairs of Monday’s Stent – Save a Life! 2017 Annual Forum. “We are here to shape the future,” he added.

The Stent – Save a Life initiative is the successor of the Stent for Life programme. As C. Naber explained, Stent for Life “was a European approach, but it then expanded rapidly beyond Europe. In 2016, countries such as Tunisia, South Africa, Egypt, India, Argentina, and Mexico were all involved; these are not European! We began to ask ourselves what the global need is for such an initiative, and this was the question that created Stent – Save a Life.”

“It does not matter where in the world a patient suffers from STEMI, we need to make sure they receive the best care we can deliver. We have differing resources and problems in each country, but this is all about our patients,” C. Naber told the attendees.

New infrastructure has been put in place to achieve this expansion. Regional boards will work to identify candidate countries and then work to produce a strategic plan, “which is always developed by representatives of the national healthcare system, the national cardiovascular society, and other partners such as cardiovascular device industry,” C. Naber said. “Over the next three years, this group needs to develop a plan for the country and make the contacts necessary to achieve the plan. Getting the regional structures working is the most important thing”.

Speaking to The Daily Wire before the session, C. Naber said, “We want to explain that for those who are already members, nothing much will change. We are increasing the presence of this initiative in the various regions, and we want to inform session attendees about the progress in different countries. We also want to speak about some general problems that we have had, and how we have found solutions; the Stent – Save a Life initiative is about structuring the process, about learning from each other. It is essential that we can learn from countries like Argentina, China, South Africa and India, who had problems that they solved that other countries can learn from.”

Monday’s session, which registered participants from 32 countries, reflected these goals and was split into three parts. The first part of the session focussed on the importance of a successful network and reflected on eight years of success for the Stent for Life programme. The session also included presentations by those involved in starting and then running a national STEMI programme, giving their insights into the internal processes behind the initiatives. The global challenges of STEMI care were then discussed, with presentations given on Latin America, Africa, and the Asia-Pacific region in general, and Mexico, China, and Tunisia in particular. C. Naber noted that by 2030, coronary disease is expected to increase by 40% in Asia, 70% in Africa and 25% in Latin America, while it will fall in Europe. “We need to shape the future and take care of all of these patients that come to us for treatment,” C. Naber said. The power of collaborative solutions was the thrust of the third and final part of the session, with views from Sri Lanka, Sudan, and Hong Kong among those featured. Closing the session, C. Naber said, “This was a great meeting. Each talk showed so much energy and so much commitment; it was very stimulating.”

Setting out key milestones for the coming year, C. Naber noted that “there are much more things to achieve.” Some key goals mentioned were the assessment of the ongoing projects, the finalisation of the programme’s survey, and the establishment of a shared clinical database.

We are reaching the end of the second year of the Stent Save a Life Argentina Initiative.

During the first year, we determined the main barriers that exist in the management of STEMI patients in our country. The most significant barrier is undoubtedly our health system that is organized around three main providers: the public system, the social security and the private insurance, which is highly fragmented with a low integration between parties.

There are multiple EMS services with absence of systematic referral pathways which, as a result, causes variations in ambulance equipments and in medical and paramedical training. In addition to this, most of the centers with and without p-PCI capacity neither have triage in the guard to speed up the diagnosis of patients with manifesting symptoms of STEMI, nor do they have STEMI pathways or door-to-balloon programs.

Apart from this situation, there is no reperfusion culture in the majority of the medical community.

In this context, we decided to choose model regions formed by private or public centers with the objective of developing door-to-balloon programs in each one.

Each pilot center must meet the following criteria to participate:

  1. To agree to work to meet the objectives of the Stent Save a Life Initiative
  2. To create a multidisciplinary team to treat STEMI patients
  3. To establish algorithms for STEMI patients based on clinical guidelines
  4. To record each patient in a common database
SFL meeting at SAC Congress 2016

We determined three goals for 2016:

1) To participate in every congress to show the progress of the SSAL Initiative.

2) To establish door-to-balloon programs in each of the model centers:

As a first step, the model centers are to organize and create multidisciplinary teams which will generate commitment and reperfusion culture, so that once they are systematized, they can integrate the emergency services and centers without p-PCI capacity in a second stage.

Regardless of whether they are private or public centers, we help to create door-to-balloon programs in each of them; in the case of private centers, we work on a second stage to integrate the EMS to preactivate the center and get the majority of patients treated within the times recommended by the clinical guidelines. Concerning the public centers, we will start working together with the Ministry of Health to create STEMI networks.

All the centers enter their patients in a common database and each month they receive a report with their times according to the first medical contact, specifying which are within the times recommended by the Guidelines and which are the ones that they have to improve.

25 pilot model STEMI centers

We started in March with 13 centers and currently there are 25 participating from 7 provinces. Every month we add new ones; by the end of November, 927 STEMI patients were included.

3) To start working with the Ministry of Health:

During our National Congress held last October, we organized a meeting with all the participating centers, with the participation of Dr. Nestor Perez Baliño, Vice Minister of the MOH, and Dr. Gabriel Gonzalez, National Coordinator of the Network Program, who have given us the support and committed to work together to develop STEMI networks in public centers.

During this meeting, three examples of STEMI networks in different stages of development were presented: the STEMI Network of public hospitals of the City of Rosario, the STEMI Network of the City of Mendoza and that of the City of Santiago del Estero.

With more than a hundred attendees, this meeting sought to reflect the commitment we have made daily to fulfill the mission of the Stent for Life Initiative.

Alfonsina Candiello, SSAL Argentina Project Manager

In 2016, the Belarusian Scientific Society of Cardiologists and the Belarusian Society of Endovascular Surgery and Interventional Cardiology have initiated the process of joining the European initiative Stent Save a Life. The goal – to improve the quality of interventional care for patients with acute coronary syndrome (ACS) and the use of best European practices in our daily work.

The Republic of Belarus is an Eastern European country with a current population of 9,481,000 approx. and a very high number of individuals suffering from Ischemic heart disease with the current prevalence rate of 10,471.1/100,000.

Approximately 15000-15500 acute MI cases are registered every year, out of which 55-65% with STEMI. While the registered acute MI mortality adding up to 15%.

The first PCI in Belarus was performed in 1989. For many years the number of PCI procedures was extremely low. During last ten years the quantity of PCI was increased up to 733 per million in 2015 (Fig. 1).

Fig.1: PCI in Belarus

In the year 2011 a national program with a purpose of improving quality of the treatment for patients with acute MI was initiated in Belarus. At present time with the help of this program we organized a system for management of ACS. This made interventional management for ACS patients accessible in all regions of Belarus with 19 PCI centers involved (Fig. 2).

Fig. 2: Map of Belarus (green dots: currently working p-PCI centers; Red circles: territories which are covered by p-PCI service)

14 PCI centers currently manage ACS in a 24/7 regimen. With the adoption of the program during last seven years there was an increase in the number of STEMI patients who received reperfusion therapy and especially p-PCI (Fig. 3). The current number of p-PCI-procedures per 1 million of population is 311 (Fig.4). Due to location of PCI centers only in big cities, current p-PCI infrastructure can cover the territory with only about a 50% of total population. In regions where immediate interventional management isn’t available, the patients are managed with thrombolytic therapy (Streptokinase or Tenecteplase) or pharmaco-Invasive strategy.

Fig. 3: Belarus: ACS with ST-segment elevation reperfusion therapy in 2009-2015
Fig. 4: Belarus: evolution of p-PCI/million

For the purpose of improving medical care for patients with ACS it is crucial to cover the rest of the country with p-PCI service. In order to make PCI accessible to the majority of population of the country, seven more centers are planned to be opened by 2020 (Fig. 5).

Fig. 5: Map of Belarus (red dots: perspective p-PCI centers; Blue circles: territories which will be covered by p-PCI service for new centers)

Aiming at increasing the availability of interventional treatment of ACS patients and as a result to decrease of mortality rate from the myocardial infarction to 10% within next 3 years, Belarusian cardiologists together with the Ministry of Health of The Republic of Belarus have developed a “road map” program.

Basic goals of the program:

  • the creation of new inter-regional PCI centers;
  • increasing the number of interventional procedures;
  • development and implementation of health care quality indicators;
  • spreading of pharmaco-invasive strategy to regions where direct transfer to p-PCI centers is geographically not possible;
  • development and optimization of pre-hospital medical care in order to reduce reperfusion therapy delays;
  • diagnostic optimization in patients with ACS without ST elevation and an increase in the availability of interventional procedures;
  • overall reduction of the number of patients who do not receive any reperfusion therapy.

Oleg Polonetsky1,2, Valery Stelmashok2, Alexander Mrochek2
1. Country Champion, SFL Belarus; 2. Republican Scientific and Practical Centre of Cardiology, Minsk, Belarus

The Stent Save a Life initiative aims to improve the delivery of care and patient access to the life saving indications of primary percutaneous coronary intervention (p-PCI), thereby reducing mortality and morbidity in patients suffering from acute coronary syndromes (ACS).


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