7th April 2017, Volume 130 Number 1453

John Elliott, Tom Kai Ming Wang, Greg Gamble, Michael Williams, Philip Matsis, Richard Troughton, Andrew Hamer, Gerry Devlin, Stewart Mann, Mark Richards, John French, Harvey White, Chris Ellis

Cardiovascular disease remains the leading cause of death globally at 31% in 2012.1 In New Zealand, cardiovascular disease accounted for 33% of all deaths in 2013.2 Diagnosis and management of…

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Summary

The presentation with a ‘STEMI’ heart attack is a dangerous medical event. Even by 2012, approximately 7% of those who reach hospital die. The 2002 National heart attack and unstable angina audit was run by cardiologists and specialist physicians who wanted to record the low levels of service available. This audit shocked the Health Ministry into action, with subsequent audits from 2007 and 2012 demonstrating ongoing improvements in services available to manage patients, which the paper describes. However, the paper also describes the need for ongoing improvements from 2012, especially in the rapid access to a cardiac angiogram, with a stent or cardiac surgery for those who need this treatment. This should occur within 24 hours.

Abstract

Aim

To audit the management of ST-segment elevation myocardial infarction (STEMI) patients admitted to a New Zealand Hospital over three 14-day periods to review their number, characteristics, management and outcome changes over a decade.

Method

The acute coronary syndrome (ACS) audits were conducted over 14 days in May of 2002, 2007 and 2012 at New Zealand Hospitals admitting patients with a suspected or definite ACS. Longitudinal analyses of the STEMI subgroup are reported.

Results

From 2002 to 2012, the largest change in management was the proportion of patients undergoing reperfusion by primary PCI from 3% to 15% and 41%; P<0.001, and the rates of second antiplatelet agent use in addition to aspirin from 14% to 62% and 98%; P<0.001. The use of proven secondary prevention medications at discharge also increased during the decade. There were also significant increases in cardiac investigations for patients, especially echocardiograms (35%, 62% and 70%, P<0.001) and invasive coronary angiograms (31%, 58% and 87%, P<0.001). Notably even in 2012, one in four patients presenting with STEMI did not receive any reperfusion therapy.

Conclusion

Substantial improvements have been seen in the management of STEMI patients in New Zealand over the last decade, in accordance with evidenced-based guideline recommendations. However, there appears to be considerable room to optimise management, particularly with the use of timely reperfusion therapy for more patients.

Author Information

John M Elliott, Cardiologist, Christchurch Hospital, Christchurch; Tom Kai Ming Wang, Cardiology Registrar, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland; Greg D Gamble, Statistician, University of Auckland, Auckland; Michael JA Williams, Cardiologist, Dunedin Hospital, Dunedin; Philip Matsis, Cardiologist, Wellington Hospital, Wellington; Richard Troughton, Cardiologist, Christchurch Hospital, Christchurch; Andrew Hamer, Cardiologist, Nelson Hospital, Nelson; Gerry Devlin, Cardiologist, Waikato Hospital, Hamilton; Stewart Mann, Cardiologist, Wellington Hospital, Wellington; Mark Richards, Cardiologist, Christchurch Hospital, Christchurch; John K French, Cardiologist, Liverpool Hospital, SW Sydney Clinical School (UNSW) Sydney, Australia; Harvey D White, Cardiologist, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland; Chris J Ellis, Cardiologist, Green Lane Cardiovascular Service, Auckland City Hospital, Auckland. For the NZ Regional Cardiac Society ACS Audit Group.

Acknowledgements

The authors would like to thank the many investigators who assisted with the three National audits, and who are acknowledged in each of the three primary papers.

Correspondence

Dr Chris Ellis, Cardiologist, Green Lane Cardiovascular Service, Auckland City Hospital, Grafton, Auckland 1023.

Correspondence Email

chrise@adhb.govt.nz

Competing Interests

Dr Hamer reports affiliation with Capricor Inc and Amgen Inc outside the submitted work. A part of Dr Hamer's income was reimbursed to Nelson Marlborough District Health Board by the Ministry of Health for New Zealand Cardiac Network responsibilities during the time that this research was performed; Dr White reports grants and non-financial support from GlaxoSmithKline during the conduct of the study, grants from Sanofi Aventis, grants from Eli Lilly and Company, grants from National Institute of Health, grants from Merck Sharpe and Dohm, grants and personal fees from AstraZeneca, grants from Omthera Pharmaceuticals, grants from Pfizer New Zealand, grants from Intarcia Therapeutics Inc, grants from Elsai Inc and grants from DalGen Products and Services outside the submitted work.

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