Worldwide procedural variations of primary percutaneous coronary intervention for ST-elevation myocardial infarction: Insights from the “Stent − Save a Life!” initiative

Background: ST-elevation myocardial infarction (STEMI) outcomes have improved through initiatives that promote timely access to primary percutaneous coronary intervention (PCI). However, little is known about how primary PCI is performed across different settings. This study proposes to characterize and compare practical aspects of primary PCI globally. Methods: An electronic survey, assessing thirteen aspects potentially affecting primary PCI timing and efficacy, was distributed to interventional cardiologists in the “Stent-Save a Life!” initiative. Comparisons were made based on geographical locations and annual PCI volume. Results: Seven hundred-and-twenty-four responses were received (59 % from Europe, 18 % from Latin America, 15 % from Asia, 9 % from Africa); 88 % of participants worked in high-volume primary PCI centers. African operators generally performed ≤75 primary PCIs annually, in contrast to their counterparts in Europe, Asia, and Latin America. Access route varied significantly across regions: radial access was used in 98 % of primary PCIs in Europe but only 53 % in Africa. Left ventriculography was more frequently performed in Latin America (25 %) and Africa (20 %) than in Europe (9 %) and Asia (6 %). Aspiration thrombectomy was performed under different conditions. Non-culprit lesion revascularization was typically completed during the index procedure or before discharge, except in Asia. Most participants from Europe (82 %) and Asia (85 %) reported pretreating their patients with P2Y₁₂ inhibitors. High-volume operators were more likely to work in 24/7 PCI hospitals, prefer radial access, and routinely perform thrombus aspirations and PCI on non-infarct-related arteries after discharge. Conclusions: This global survey identified procedural variations in performing primary PCI, indicating room for improvement, particularly in the African region.