PPCI network in Bosnia and Herzegovina

A STEMI network in Bosnia and Herzegovina was established in 2010 and is made up of six PCI-capable centres. Despite the increase in number of patients treated with PPCI after the network was implemented, the overall use of reperfusion therapy remains low, with as many as 41% of patients receiving no reperfusion therapy.

Barriers to rapid reperfusion

Pre-hospital barriers are related to infrastructure and patient education/delays. The main in-hospital barriers to treating STEMI patients in Bosnia and Herzegovina with PPCI is the lack of personnel – there is only a staggering 24 interventional cardiologists for nearly 4 million inhabitants – and a decline in insurance reimbursement. Post-procedure phase barriers are due to a lack of skilled medical staff to care specifically for PCI patients.


Dilic et al. have put out a call-to-action to address each barrier level in STEMI patient care, namely, patient education and campaigns (pre-hospital), increase use of fibrinolysis (tenecteplase) and possibly pharmaco-invasive strategy (in-hospital), and keeping health care professionals caring for STEMI patients up-to-date with technology and the latest evidence-based practices (post-procedure phase).

Overall, these systematic changes may improve access to reperfusion therapy throughout the Bosnia and Herzegovina.


  1. Dilic M, et al. Primary percutaneous coronary intervention network in Bosnia and Herzegovina: Where are we now and how to improve PCI network. Int J Cardiol 2016;217:S49-S51.