Angioplasty in acute myocardial infarction after low-dose alteplase and abciximab in transferred patients. A comparison with primary angioplasty on site.
BACKGROUND
The most important limitation in primary percutaneous coronary interventions (PCI) for acute myocardial infarction (AMI) is the small number of catheterization laboratories and their non-homogeneous territorial distribution. The aim of this study was to evaluate the safety and efficacy of an organizational model based on a network including tertiary referral centers and community hospitals for the treatment of AMI with alteplase plus abciximab followed by PCI.


METHODS
From October to November 2002, 232 patients < or = 75 years with AMI at high risk (84 transferred from four community hospitals and 148 patients admitted directly at the tertiary center) underwent PCI at our Institution. We compared procedural results and clinical outcome in patients with AMI undergoing PCI with or without transfer to tertiary centers.


RESULTS
Patient transferal from community hospitals determines a greater door-to-balloon time (120 vs 55 min, p < 0.001), while complications observed during transportation are limited (5.9%). Transferred patients have a greater percentage of infarct-related artery patency (77 vs 22%, p < 0.001) and of ST-segment resolution 90 min post-PCI (77 vs 57%, p < 0.005) in comparison with direct-access patients. The incidence of clinical events (death, reinfarction, angina) was not different between the two groups at 30 days and at 6 months of follow-up.


CONCLUSIONS
In our experience the integrated model between tertiary centers and community hospitals represents a valid network system offering homogeneous therapeutic (alternatives) options to all patients with AMI regardless of the hospital where they are first admitted.
Manari
Antonio
A
U.O. di Cardiologia Interventistica Azienda Ospedaliera S. Maria Nuova Viale Risorgimento, 80 42100 Reggio Emilia. manari.antonio@asmn.re.it
Guiducci
Vincenzo
V
Muià
Nicola
N
Giacometti
Paola
P
Fioroni
Stefano
S
Navazio
Alessandro
A
Gambarati
Gianpaolo
G
Bendinelli
Stefano
S
Bruno
Gabriele
G
D000077284:Abciximab; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000401:mortality; D004305:Dose-Response Relationship, Drug; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage*; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology / Q000628:therapy*; D010343:Patient Admission; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D012086:Reoperation; D016019:Survival Analysis; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D014187:Transportation of Patients; D016896:Treatment Outcome; D014654:Vascular Patency / Q000502:physiology
D000911:Antibodies, Monoclonal; D005343:Fibrinolytic Agents; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D010959:Tissue Plasminogen Activator; D000077284:Abciximab