Abstract Background Outcome of STEMI patients has improved in the last years, with better survival due to an improved onset of symptoms to balloon time, and better pharmacological and nonpharmacological treatment. However, influences of seasonal differences are not studied yet. Purpose To identify differences in clinical features, associated comorbidities, and outcome of ST-elevation myocardial infarction (STEMI) patients, related to seasonal differences, in a temperate continental climate. Methods We examined data from the electronic STEMI registry from a high-volume PPCI center. We analyzed retrospectively data from 518 STEMI patients, managed invasively, admitted in the last year. We compared clinical features, comorbidities, and outcome, between winter months (December, January, and February) and summer months (June, July, and August). Results 269 (52%) patients (74% men, median age 61 years) were admitted during winter months, while 249 (48%) patients (80% men, median age 59 years) were admitted during summer months. Killip class at admission was higher during winter (χ2=10.2; p=0.017), with significant differences for all Killip classes (Killip I: 83% winter vs. 92% summer; Killip II: 8.6% winter vs. 4.4% summer; Killip III: 3.7% winter vs. 1.2% summer; Killip IV: 4.5% winter vs. 2.0% summer, p=0.04). Meanwhile, maximal Killip class anytime during hospitalization was higher during winter (χ2=9.7; p=0.021). In terms of comorbidities, a trend toward more frequent atrial fibrillation (AF) was recorded during winter (5.2% vs. 2,0%; χ2=3.7; p=0.053). Severe left ventricular dysfunction (LVEF<30%) was more frequent among patients admitted in winter (9.7% vs. 4.4%; χ2=5.4, p=0.020). In-hospital mortality was higher during winter (9.7% vs. 4.4%; χ2=5.4; p=0,020). We computed a predictive model for in-hospital death for STEMI patients, using stepwise logistic regression analysis. Independent significant predictors were seasonal months, blood glycemia, and creatinine (χ2=53.3, p<0.005). Patients with STEMI admitted during winter months had a 2.8-fold increase in probability of death during index hospitalization compared with summer months. Conclusions Winter months are associated with worse clinical features, more frequent AF, worse LV function, and higher risk of death of STEMI patients managed invasively than summer months. We consider temperature differences, changes in air pressure, decrease in physical activity, and increase in food intake as possible explanations for worse evolution of winter patients. A prospective dedicated research is necessary to provide detailed explanations.

Background: Before 2010 less than 15% of patients (pts) with ST-elevation myocardial infarction (STEMI) were treated by primary percutaneous coronary intervention (PPCI) in Romania. Objective: To evaluate the impact of the program on the in-hospital mortality and type of reperfusion, 30 months after its onset. Methods: Our program for PPCI was opened in August 2010 for treating STEMI patients by PPCI within the first 12 hours after the STEMI onset. Based on a regional dispatch system pts were either directly transported to the on duty PCI center (if within the first 2 hours after the first medical contact) or after local thrombolysis (if time of transport was longer). This program is based on 6 components: 1. A detailed written project; 2. A special state budget covering the costs of equipment (including stents); 3. An integrated pre-hospital emergency medical system; 4. Twelwe experienced PPCI centers organised in a 24/7 system in 5 regional networks; 5.a specific program for training the dedicated staff in interventional cardiology; 6. A national RO-STEMI registry for monitoring the program implementation. This program is a cooperative effort between the Health Ministry and the Romanian Society of Cardiology. Results: From 2010 to 2012, a total of 22,975 patients with STEMI were included into the RO-STEMI registry. Patients treated by PPCI increased from 1289 (25.0%) in 2010, to 4209 (49,3%) in 2011, and 5188 (55,9%) in 2012; patients receiving thrombolysis decreased from 17,1%, to 10.3%, and 9.0%; percentage of patients not receiving reperfusion therapy decreased from 57,8%, to 40,4%, and 35,8%. The national in-hospital mortality due to STEMI decreased from 12.2%, to 9.9%, and 7.9%, respectively. The in-hospital mortality (for 2012) related to the type of reperfusion was 4.7%, 8.3%, and 12.3% for PPCI, thrombolysis, and no-reperfusion patients, respectively. Conclusions: Since the onset of our national program for the interventional therapy of STEMI (2012 vs 2010): (1) PPCI increased by 120%; (2) patients treated by reperfusion therapy increased to 65% (56% by PPCI and 9% by thrombolysis); (3) in-hospital mortality decreased by 35%. This is one of the most successful national programs in cardiology within Europe, proving that aggressive implementation is possible, by collaboration between professional organization and the Health Ministry.

A national programme for PPCI in STEMI patients was started in Romania in August 2010, based on an integrated and well-trained pre-hospital emergency medical system. Ten national centres experienced in PPCI were organised in a 24/7 system in five regional networks, in order to assist STEMI patients from areas offering PPCI within the first two hours after the first medical contact. For centres located further away, a strategy of local thrombolysis followed by transfer to the closest PCI centre was recommended. The total number of PPCI procedures increased from 1,289 in 2010 to 4,209 in 2011. The percentage of PPCI increased from 25.0% in 2010 to 49.32% in 2011. From 40 PPCI/million inhabitants in 2009, we reached 64/million in 2010 and 210/ million in 2011. In the Bucharest area there were 640 PPCI/ million in 2011. The global in-hospital mortality decreased from 13.5% in 2009 to 9.93% in 2011. In 2011 in-hospital mortality was 4.39%, 8.32% and 17.11% for PPCI, thrombolysis and no-reperfusion, respectively. In-hospital mortality was 7.28% in the PCI centres but 14.20% in centres without PCI facilities. The national programme for PPCI had a major impact on STEMI in-hospital mortality in Romania.