The impact of systemic changes on quality of care providing in acute myocardial infarction in Ukraine

For the past 5 years, the system of providing medical care to patients with acute myocardial infarction (AMI) has radically changed in Ukraine. The accession of our country to the European initiative "Stent for Life" contributed to the creation of the national reperfusion network. It ensured the wide availability of medical care for patients with AMI due to the fastest delivery of patients to clinics that provide a 24-hour emergency coronary artery stenting. Nowadays in Ukraine, 42 reperfusion centers are successfully operating 24/7/365 care delivery and more than 50% of patients with AMI undergo primary percutaneous coronary intervention (PCI). Almost 70% of patients are delivered to clinics within the first 6 hours after the onset of AMI symptoms, which corresponds to the obligatory “therapeutic window” for emergency PCI. The average number of primary PCI performed in AMI increased by 4 times in 2018 compared to 2012, reaching 286 procedures per 1 million population. The structure of reperfusion therapy has qualitatively changed in 2016. The total number of reperfusion procedures increased due to a decrease of thrombolytic therapy cases and an increase in the frequency of using the most effective method – primary coronary stenting in patients with STEMI. Systemic changes in the structure of medical care providing to patients with AMI contributed to a decrease in hospital lethality in patients with AMI - from 14,1% in 2012 to 13,81% in 2019.