[Transfer of high-risk patients with acute myocardial infarct for subsequent coronary angioplasty. Some considerations].
For invasive therapeutic options in patients with acute myocardial infarction admitted to hospitals without angioplasty facilities, immediate transfer to a referral "tertiary" center is needed. The background for this therapeutic strategy is the benefit in clinical outcome of primary coronary angioplasty when compared with thrombolysis, especially for high risk patients with acute myocardial infarction. Rescue coronary angioplasty also is interesting, because of additional delay due to transfer. A functional example of interhospital "network" is Zwolle (The Netherlands) where Weezenlanden Hospital is a referral center performing primary angioplasty in many high risk patients with acute myocardial infarction transferred from community hospitals. A large multicenter randomized trial is needed to compare thrombolysis in a local hospital with primary angioplasty after transfer. However available studies show feasibility and safety of such a therapeutic option. Organizing implications are very complex; moreover rational and homogeneous territorial distribution of hospitals with coronary angioplasty facilities in needed.
Cesaroni
P
P
Unità Operativa di Cardiologia, Azienda Ospedaliera San Salvatore, Pesaro. cesa50@libero.it
Sgarbi
E
E
D015906:Angioplasty, Balloon, Coronary; D002300:Cardiac Care Facilities / Q000458:organization & administration*; D005342:Fibrinolysis; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy*; D010360:Patient Transfer; D017410:Practice Guidelines as Topic; D016879:Salvage Therapy; D013997:Time Factors