Improving acute and long-term myocardial infarction care : bridging the gap between science and practice

Abstract

The main topic of this thesis was the design, implementation and subsequent evaluation of an all-phases integrated care program for patients with acute myocardial infarction: the MISSION! protocol. The aim of MISSION! was to improve daily care for patients with an acute myocardial infarction by implementation of the most recent guidelines into clinical practice. Although prior surveys did show an improvement of care over the years, still a major gap exists between optimal care and daily clinical practice. Important aspect of MISSION! was the alignment of treatment strategies of the different healthcare professionals involved in the treatment of AMI patients. By doing so, unnecessary and harmful treatment delays were reduced and long-term care for patients with an acute myocardial infarction was improved. Within the implementation of the MISSION! protocol it became possible to perform clinical evaluation studies. For example, the development of left ventricular remodeling after myocardial infarction was studied. By early identification of patients prone to develop left ventricular dilatation it may become possible to intervene at an early stage by optimizing drug-treatment, surgery or resynchronization therapy. In this thesis, the results of two studies are reported aimed at identifying predictors of left ventricular remodeling after acute myocardial infarction. Moreover, studies were performed to investigate plaque characteristics of the infarct-related coronary artery and to evaluate the use of drug-eluting stents in patients with acute myocardial infarction. In the SHIVA study, conventional cardiovascular risk factors and Framingham-risk scores were assessed in asymptomatic 3rd to 7th generation Asian Indian descendants, compared to Europeans. It appeared that young Asian Indians exhibited frequently an unfavorable cardiovascular risk profile.