Background: According to the annual “german heart report”, morbidity and mortality of acute myocardial infarction is higher and above the nationwide average in the eastern states of Germany. Current guidelines recommend regional STEMI-networks and participation in a quality assessment program to secure and improve quality of acute care. Thuringia is a state in central and east Germany, and is characterized by mainly rural landscape instead of metropolitan areas. Thus, timely care of acute ST-elevation myocardial infarction might be challenging. So far, current and valid data for quality of STEMI care in Thuringia are lacking.

Aim: We aimed to analyze STEMI outcomes, mortality rates and distribution of comorbidities and cardiovascular risk factors in Thuringia. An independent, prospective state-wide STEMI registry (ThIN – Thuringian Infarction Network) was established to continously analyze and improve quality of STEMI care.

Methods: All STEMI patients in participating hospitals were anonymized and prospectively included in an electronic database. Various administrative, procedural, therapeutic and clinical parameters were recorded for each case. Pre- and intrahospita time lines (e.g. symptom onset, first medical contact, ECG recording, contact-to wire or door-to wire times) were mostly collected in “real”-time during PPCI.

Results: Between 01/2018 and 06/2021 a total of 1.125 STEMI patients (65.6 ± 13.7 years, 70.8 % males) were registered from 9 participating hospitals with 24/7 cath labs. Tables 1 and 2 show clinical and procedural characteristics. We found a high rate of active smokers (54.3 %) and an even higher percentage of patients with a medical history of past or active smoking (65.0 %). Roughly one third of the patients are diabetics, which were insufficiently controlled (HBA1c 7.5 ± 1.7). Secondary prevention in patients with prior known atherosclerotic cardiovascular disease or diabetes was poor (LDL 2.80 ± 1.24 mmol/l and 3.03 ± 1.25 mmol/l, respectively). Almost all patients received primary PCI for acute reperfusion therapy with a median of 87 min contact-to-wire time (P25: 69 min; P75: 118 min) and a median of 46 min door-to-wire time (P25: 32 min; P75: 72 min), and thus within guideline recommended time goals. Ejection fraction at discharge was preserved in 49.3 %, and severely impaired in only 10.9 % of patients. However, 12.8 % of acute STEMI patients presented with cardiogenic shock, and mortality was 48.3 % in these shock patients (Tab.2). Overall, in-hospital mortality was 12.6 % and mortality of STEMI patients without shock was 7.4 %. Postinfarction therapy is shown in table 3 and carried out according to guideline recommendation. Almost all patients received lipid lowering therapy with a high potent statin (atorvastatin) in 89.3% and even ezetimibe in 16.3 % of cases.

Conclusion: Acute reperfusion therapy for STEMI is of high quality in hospitals participating in the Thuringian Infarction Network. In-hospital mortality is comparable to european STEMI data and show no peculiarities. However, distribution of cardiovascular risk factors, especially unhealthy lifestyle behavior like smoking and comorbidities like diabetes and hyperlipidemia are poorly controlled. This might explain the divergence of high quality acute care with favorable acute STEMI outcomes (ThIN) vs. generally higher mortality and morbidity rates (annual german heart report), and calls for dedicated primary and secondary prevention programs.