[Network for the treatment of acute myocardial infarction in the province of Mantova: results after 2 years of work].
BACKGROUND
Since June 2001, in the province of Mantova, we have been carrying out a program for the management of acute myocardial infarction based on early assessment of the patients' risk profile, on telematic connection among care centers and on optimization of in- and out-of-hospital critical pathways for the access to care.


METHODS
Our network provides connection among the following centers: advanced life support ambulances, 7 hospitals, 3 coronary care units, 1 cath lab on call 24 hours a day for primary angioplasty, 1 thoracic surgery division. This program, through its strong telematic platform, allows early assessment of myocardial infarction, and provides primary angioplasty to all high-risk patients, being fibrinolytic treatment reserved only to the low-risk patients admitted in peripheral hospitals.


RESULTS
Two hundred and twenty patients with acute myocardial infarction were treated with angioplasty; 179 (81%) patients underwent primary angioplasty, 26 (12%) patients facilitated angioplasty and 15 patients (7%) rescue angioplasty; 121 patients (55%) were first admitted in the Mantova hospital, 65 patients (30%) were referred to Mantova from peripheral hospitals and 34 patients (15%) were directly transported to the cath lab by advanced life support ambulances. Procedural success was obtained in 98% of cases, with 05% intraprocedural mortality. In-hospital mortality was 55%, while mortality of cardiogenic shock patients was 36%. Recurrence of acute myocardial infarction occurred in 1% and major bleeding in 2.2% of patients. One patient with cardiogenic shock died during transport. Mean door-to-balloon time was 73 min with 39% reduction in the second period of recruitment after telematic connection.


CONCLUSIONS
This program, developed in the setting of a provincial network for the management of acute myocardial infarction, provided primary angioplasty to all high-risk patients, with a high procedural success rate. Within a few months, time to treatment was minimized by the employment of telematic facilities.
Zanini
Roberto
R
Dipartimento di Cardiologia, Azienda Ospedaliera "Carlo Poma", Mantova. cardiomantova@virgilio.it
Lettieri
Corrado
C
Romano
Michele
M
Buffoli
Francesca
F
Izzo
Antonio
A
Schiavone
Giorgio
G
Baccaglioni
Nicola
N
Aroldi
Marco
M
Ferrari
Mariarosa
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019058:Community Networks / Q000458:organization & administration; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D017216:Telemedicine; D013997:Time Factors