[Coronary disease: early intervention saves lives. Treatment of acute myocardial infarction in Mantova: results of thirty months of work after the implementation of a province network].
BACKGROUND
Since June 2001, in the province of Mantova, we have undertaken a program for the management of acute myocardial infarction based on the early assessment of patient risk profiles, concerning telematic connections among care centers and on the optimization of in-hospital and out of hospital critical pathways for access to care.


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


RESULTS
Two hundred and eighty patients with acute myocardial infarction were treated with angioplasty; 224 patients (80%) underwent primary angioplasty, 36 patients (13%) facilitated angioplasty and 20 patients (7%) rescue angioplasty. One hundred and thirty-two patients (47%) were first admitted to Mantova Hospital; 78 patients (28%) were referred to Mantova from peripheral hospitals and 70 patients (25%) were directly transported to the cath lab by advanced life support ambulances. Procedural success was obtained in 98% of patients, with 0.4% intraprocedural mortality. In-hospital mortality was 5.7%, while mortality in cardiogenic shock patients was 36%. The recurrence of acute myocardial infarction occurred in 1% of patients and major bleeding occurred in 2.2% of patients. One patient with cardiogenic shock died during transport. Mean door to balloon time was 67 min with a 42% reduction in the 3rd recruitment period.


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 use of telematic facilities.
Zanini
R
R
Divisione di Cardiologia, Azienda Ospedaliera 'Carlo Poma', Mantova - Italy. cardiomantova@virgilio.it
Romano
M
M
Buffoli
F
F
Lettieri
C
C
Izzo
A
A
Baccaglioni
N
N
Aroldi
M
M
Tomasi
L
L
Kuwornu
H
H
Pepi
P
P
D015906:Angioplasty, Balloon, Coronary; D003327:Coronary Disease / Q000150:complications / Q000401:mortality / Q000628:therapy; D006801:Humans; D007558:Italy; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D013997:Time Factors