Primary angioplasty in Portugal during the stent for life / stent save a life initiative: where do we stand?
C Martins, H Pereira, E Pereira, R Cale, R Pereira, J SilveiraAbstract
Introduction
The Stent for Life/Stent Save a Life (SFL/SSL) programme, launched in 2011, aimed to reduce delays in ST-elevation myocardial infarction (STEMI) treatment and increase access to primary percutaneous coronary intervention (PPCI). Momento 25 provides a new national assessment of the Portuguese PPCI network. This study compares key performance indicators from 2011–2025, identifies opportunities for improvement and highlights the importance of continuous monitoring of reperfusion times, including critical intervals, operational targets and regional variations.
Methods
Data from Moments 0–6 (M6, n=1652) and Moment 25 (M25, n=249) were analysed. Variables included patient delay (symptom-to-FMC), system delay (FMC-to-reperfusion), FMC-to-ECG, type of first medical contact (INEM vs self-transport), compliance with guideline targets (ECG ≤10 min; door-to-balloon ≤60 min; FMC-to-balloon ≤90 min; symptom-to-balloon ≤120 min) and initial admission to centres with and without PPCI.
Results
No significant differences were found for patient or system delay. Overall compliance with guideline-recommended timings also showed no significant changes, although Moment 25 recorded the highest door-to-balloon performance (59.6%). INEM activation increased steadily across study periods, from 35.2% in Moment 0 to 49.4% in Moment 25 (p<0.001). Significant differences in target compliance were observed between patients with and without INEM activation (Table 1). A marked reduction in initial admission to non-PPCI hospitals was noted, from 54.5% in Moment 0 to 28.9% in Moment 25 (p<0.001). Regional disparities persisted, with presentation to non-PPCI centres ranging from 36.5% in Lisbon and Tagus Valley to 54.3% in Alentejo.
Conclusions
Throughout the SFL/SSL initiative, sustained growth in INEM activation was observed, accompanied by improved network efficiency, reflected in higher proportions of patients reperfused within ≤90 min, and reduced admission to hospitals without interventional cardiology. However, significant delays and regional inequalities persist, compromising equitable access to PPCI. Strengthening cardiovascular emergency literacy, encouraging early INEM activation and reorganising regional networks are essential to improve and consolidate the gains achieved.