[Can primary angioplasty result in the increase of the number of hemodynamics laboratories?].
Randomized studies comparing primary angioplasty with fibrinolysis have shown that mechanical intervention is superior to fibrinolytic treatment in terms of effective reperfusion, resulting in a decreased mortality rate and a lower incidence of reinfarction and recurrent ischemia. However, the effectiveness of a primary angioplasty strategy is strongly dependent on logistic models. Survey studies, and the GUSTO IIb trial have shown no clinical benefits of primary angioplasty over pharmacologic treatment in the "real world". Thus, a primary angioplasty program should be considered only if high performance technical and logistic models can be applied. These include surgical back-up, high volume cath lab, and an effective network of patient transportation, and as a consequence, the most cost/effective model may be identified in a tertiary referral center, and in the regionalization of the myocardial infarction centers.
Antoniucci
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Divisione di Cardiologia, Ospedale di Careggi, Firenze.
D017130:Angioplasty / Q000191:economics; D002986:Clinical Trials as Topic; D003365:Costs and Cost Analysis; D006439:Hemodynamics; D006801:Humans; D007558:Italy; D007753:Laboratories / Q000191:economics / Q000706:statistics & numerical data*; D009203:Myocardial Infarction / Q000628:therapy*; D012042:Registries; D014481:United States
L'angioplastica primaria può essere motivo di moltiplicazione dei laboratori di emodinamica?