EPICOR (long-tErm follow-uP of anti-thrombotic management patterns In acute CORonary) is an international cohort study which aims to evaluate international patterns of pre- and in-hospital care of patients with acute coronary syndromes (ACS).
The study enrolled 10,568 consecutive ACS survivors from September 2010 to March 2011 from over 550 hospitals throughout Europe and Latin America. Differences in treatment strategy were analysed.
The main findings in STEMI patients (n=4943) is summarised here.
In STEMI patients, the global median time from symptom onset to:
- FMC or pre-hospital ECG was 1.5 hours.
- PPCI was 4.1 hours.
Globally, 75.5% of STEMI patients underwent reperfusion therapy (56.2% PPCI and 19.3% fibrinolysis). Although the overall rate of reperfusion is acceptable, rates varied by region. For example, more than a third of STEMI patients in Latin American did not receive reperfusion therapy at all (see figure). Furthermore, the results show a need to improve pre-hospital care. Only 49.3% of STEMI patients received pre-hospital care (ECG and/or anti-thrombolytic therapy). Only 2% of STEMI patients received pre-hospital fibrinolysis. The investigators note that the low use of pre-hospital fibrinolytic therapy may be attributed to the high rates of PPCI in some regions. However, this does not explain the low use of pre-hospital fibrinolysis in Latin America where fibrinolysis tends to be the dominant method of reperfusion. The investigators further encourage an increase in the use of pre-hospital ECG which in turn can lead to earlier diagnoses and reduce symptom-onset-to-treatment times, in patients treated with fibrinolysis and PPCI alike.
STEMI managment strategies by region
- Bueno H, et al. Opportunities for improvement in anti-thrombotic therapy and other strategies for the management of acute coronary syndromes: Insights from EPICOR, an international study of current practice patterns. Eur Heart J Acute Cardiovasc Care 2016;5(1):3-12.