title: [Impact of reperfusion strategies on in-hospital outcome in ST-elevation myocardial infarction in a context of interhospital network: data from the prospective VENERE registry (VENEto acute myocardial infarction REgistry].
abstract: BACKGROUND
  Primary angioplasty (pPCI) is the most effective reperfusion treatment of acute ST-elevation myocardial infarction (STEMI), but logistic- and organization-related problems could affect the outcome. The aim of this study was to investigate the in-hospital outcome according to reperfusion strategy in the Veneto Region cardiology network.
  
  
  METHODS
  A treatment protocol, aimed to treat patients with high-risk STEMI by pPCI on-site or after transport, was developed and shared by the majority of cardiology departments in the Veneto Region. Data of all consecutive patients with STEMI were prospectively recorded during a 6-month period.
  
  
  RESULTS
  999 patients with symptom onset < 12 hours were admitted to the 28 participating hospitals: 860 were treated on-site and 139 were transferred from the admitting hospital to an interventional center for PCI. Overall, 82% of patients were treated with reperfusion therapy. Ten patients died immediately before any treatment could be initiated. In 170 patients who did not receive any reperfusion treatment, in 302 patients who received fibrinolysis (and eventually rescue PCI) and in 517 patients sent to pPCI, the following in-hospital outcome was observed respectively: mortality rate 10, 6.95 and 6.57%; reinfarction rate 0.6, 1 and 0.4%; incidence of stroke 1.7, 1.4 and 0.9%; the need for urgent revascularization procedure 6.5, 10 and 2.3%. After adjustment for confounding variables, the in-hospital occurrence of the combined events was significantly lower in patients treated with pP-CI (odds ratio 0.33, confidence interval 0.20-0.53, p < 0.01) as well as a trend for a reduced in-hospital mortality was observed (odds ratio 0.51, confidence interval 0.26-1.03, p = 0.06).
  
  
  CONCLUSIONS
  In the VENERE registry, patients treated with pPCI had a better in-hospital outcome as compared to those treated with fibrinolytic strategy.
authors.affiliation: Dipartimento Cardiovascolare, Ospedale Umberto I, Mestre (VE). francesco.dipede@ulss12.ve.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Di Pede
authors.forename: Zoran
authors.initials: Z
authors.lastname: Olivari
authors.forename: Elena
authors.initials: E
authors.lastname: Schievano
authors.forename: Paolo
authors.initials: P
authors.lastname: Spolaore
authors.forename: Luisa
authors.initials: L
authors.lastname: Cacciavillani
authors.forename: Luigi
authors.initials: L
authors.lastname: La Vecchia
authors.forename: Andrea
authors.initials: A
authors.lastname: Bruni
authors.forename: Guerrino
authors.initials: G
authors.lastname: Zuin
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Franco
authors.forename: Osvaldo
authors.initials: O
authors.lastname: Palatini
authors.forename: Giorgio
authors.initials: G
authors.lastname: Morando
authors.forename: Monica
authors.initials: M
authors.lastname: Tinto
authors.forename: Maurizio
authors.initials: M
authors.lastname: Rossi
authors.forename: Mauro
authors.initials: M
authors.lastname: Guarnerio
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D003325:Coronary Care Units; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006329:Heart Conduction System / Q000503:physiopathology*; D006761:Hospitals; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015425:Myocardial Reperfusion; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents