Improving STEMI Management Internationally: Initial Report of the American College of Cardiology-Global Heart Attack Treatment Initiative.

Background: The burden of ST-segment elevation myocardial infarction (STEMI) worldwide is increasing as the leading cause of death; there are scant data on system-based initiatives and performance metrics relative to its management in low- and middle-income countries where resources are frequently limited. Objectives: The Global Heart Attack Treatment Initiative (GHATI) ultimate aim is improving evidence-based STEMI care, adherence to guidelines, and tracking of clinical and institutional indicators in low- and middle-income countries. To achieve that goal, the process of care and outcomes of STEMI patients in those nations will be studied. Methods: In this initial phase of GHATI (2019-2021), prospective analyses of selected STEMI metrics derived from the American College of Cardiology Chest Pain MI Registry were undertaken in 18 international hospitals, most located in developing countries unfamiliar with quality improvement metrics. Results: Of 4,092 patients enrolled, complete data were available in 3,914 consecutive STEMIs included here: 80.5% male; 35.5% smokers; shock on arrival in 10%; and 5.1% with cardiac arrest before intervention. Overall, a 2% improvement on combined endpoints (shock; arrest before or after intervention; final ejection fraction <40%; survival at discharge) was observed over time, and survivorship also increased by 2% ( Conclusions: This global contemporary registry successfully enrolled STEMI patients in nations generally unfamiliar with quality improvement metrics; trends of improvement in their care were observed. GHATI may facilitate implementation of policies aimed at enhancing outcomes of cardiovascular disease worldwide, particularly in countries with evolving economies.