Stent-Save a Life! Argentina Initiative

Alfonsina Candiello, Ignacio Cigalini, Pedro Zangroniz, Alejandro García Escudero, Leonardo Ripa, Leandro Lasave, Fernando Cohen, Andrés Pascua, Santiago Coroleu, Jorge Belardi


Introduction: The Stent-Save a Life! (SSL) initiative is a European program that seeks to improve the access of patients withST-segment elevation acute myocardial infarction (STEMI) to reperfusion therapies based on clinical guideline recommendations,thus reducing morbidity and mortality.Objective: The aim of this study was to describe the results of the first three years of the SSL Argentina initiativeMethods: Initially, a mapping was carried out to analyze the local situation and then the Door-to- Balloon Program (DBP) wasdeveloped as a continuous improvement process for centers with primary percutaneous coronary intervention (pPCI) capability.Results: From March 2016 to March 2018, 3,041 patients with STEMI were treated in 38 centers participating in this program.In 20% of cases (n=610) patients had their first medical contact with the emergency medical services. After excluding 184 patients(6%) without coronary lesions, reperfusion therapy was performed in 93% of cases, mainly by pPCI (95%). Total ischemictime was 117 minutes, with differences according to the time of first medical contact. Overall in-hospital mortality was 7%.Conclusions: The lack of a “reperfusion culture” was the common barrier of public and private centers that motivated thedevelopment of the DBP. The identification of critical points that prevent treatment on time, together with enhancement ofin-hospital organization, represent the first step to improve the care of these patients. The integrated work of all the involvedparties is necessary to develop care networks adapted to the local reality of each center and region.


Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al; ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J 2018;39:119-77.

Boersma E, Maas AC, Deckers JW, Simoons ML. Early thrombolytic treatment in acute myocardial infarction: reappraisal of the golden hour. Lancet 1996;348:771-5.

Ferrante D, Tajer C. ¿Cuántos infartos hay en la Argentina? Rev Argent Cardiol. 2007;75:161-2.

Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet 2003;361:13-20.

Ellis SG, da Silva ER, Heyndrickx G, Talley JD, Cernigliaro C, Steg G, et al. Randomized comparison of rescue angioplasty with conservative management of patients with early failure of thrombolysis for acute myocardial infarction. Circulation 1994;90:2280-4.

Kaifoszova Z, Alexander T, Snyders A, Lugo Gavidia L. Stent for Life Initiative: leading example in building STEMI systems of care in emerging countries. Eurointervention 2014;10 (Suppl T):T87-T95.

Cequier A, Ariza-Solé A, Elola F, Fernández-Pérez C, Bernal J, Segura J, y cols. Impacto en la mortalidad de diferentes sistemas de asistencia en red para el tratamiento del infarto agudo de miocardio con elevación del segmento ST. La experiencia de España. Rev Esp Cardiol 2017;70:155-61.

Salud DdEeId. Información Básica. Argentina - Año 2016. Estadísticas Vitales. 2017;5.

Gagliardi J, Charask A, Perna E, D’ Imperio H, Bono J, Castillo Costa Y, y cols. Encuesta Nacional de infarto agudo de miocardio con elevación del ST en la República Argentina (Argen-IAM-ST). Rev Argent Cardiol 2016;84:548-57.

García Aurelio M, Cohen Arazi H, Higa C, Gómez Santa María H, Mauro V, Fernández H, y cols. Infarto agudo de miocardio con supradesnivel persistente del segmento ST. Registro multicéntrico SCAR (Síndromes Coronarios Agudos en Argentina) de la Sociedad Argentina de Cardiología. Rev Argent Cardiol 2014;82:259-67.

Widimsky P, Wijns W, Fajadet J, de Belder M, Knot J, Aaberge L, et al. Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries. Eur Heart J 2010; 31:943-57.

Bagai A, Jollis J, Dauerman H, Peng S, Rokos I, Bates E, et al. Emergency department bypass for ST-segment-elevation myocardial infarction patients identified with a prehospital electrocardiogram: a report from the American Heart Association Mission: Lifeline program. Circulation 2013;128:352-9.

Steg P, Cambou J, Goldstein P, Durand E, Sauval P, Kadri Z, et al. Bypassing the emergency room reduces delays and mortality in ST elevation myocardial infarction: the USIC 2000 registry. Heart 2006;92:1378-83.

Cherro A, Fernández Pereira C, Torresani E, Mauro DO, Ingino CA, Álvarez JA, y cols. Resultados hospitalarios y factores asociados con morbimortalidad del Registro Argentino de Angioplastia Coronaria (RADAC). Rev Argent Cardiol 2012;80:461-70.

Alexander T, Mullasari A, Kaifoszova Z, Khot U, Nallamothu B, Ramana R, et al. CSI Forum: Consensus Statement. Framework for a National STEMI Program: Consensus document developed by STEMI INDIA, CArdiological Society of India and Association Physicians of India. Indian Heart J 2015;67:497-502.

Alexander T, Mullasari A, Joseph G, Kannan K, Veerasekar G, Victor S, et al. A System of Care for Patients With ST Segment Elevation Myocardial Infarction in India. The Tamil Nadu-ST-Segment Elevation Myocardial Infarction Program. JAMA Cardiol 2017;2:498-505.

Full Text


  • There are currently no refbacks.

Licencia Creative Commons
The documents published in this journal are under the licencia Creative Commons Atribución-NoComercial-Compartir-Igual 2.5 Argentina.

Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020