title: Management of acute myocardial infarction in the real world: a summary report from The Ami-Florence Italian Registry.
abstract: The Florence Acute Myocardial Infarction registry was a population-based, prospective study aimed at identifying the determinants of coronary reperfusion therapy [CRT, by primary coronary intervention (PCI) in more than 95% of cases] utilization and of prognosis in patients with ST-segment elevation myocardial infarction (STEMI). The registry involved one teaching hospital with, and five district hospitals without PCI facilities. Overall, as many as 45.6% of 930 cases of STEMI did not receive any form of CRT. In multivariable analysis, the direct admission to the teaching hospital was the strongest positive predictor, whereas the time delay, older age, and chronic comorbid conditions were negative predictors of CRT utilization. Compared to conservative therapy, CRT was associated with a remarkably reduced 12-month mortality, after adjusting for age, chronic comorbidities and Killip class, which also were significantly associated with long-term prognosis. The higher crude mortality observed in women was accounted for by older age and other age-related factors. The improvement in prognosis with CRT was larger in older patients and/or in those with a greater burden of chronic comorbidity, who less frequently received CRT. These results suggest the need for interdisciplinary reassessing the adherence to therapeutic guidelines and the criteria adopted in the real clinical world to select patients for CRT during STEMI.
authors.affiliation: Epidemiology Unit, Azienda Sanitaria Firenze, Viale Michelangelo 41, 50125 Florence, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Balzi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Barchielli
authors.forename: Giovanni Maria
authors.initials: GM
authors.lastname: Santoro
authors.forename: Nazario
authors.initials: N
authors.lastname: Carrabba
authors.forename: Eva
authors.initials: E
authors.lastname: Buiatti
authors.forename: Cristina
authors.initials: C
authors.lastname: Giglioli
authors.forename: Serafina
authors.initials: S
authors.lastname: Valente
authors.forename: Giorgio
authors.initials: G
authors.lastname: Baldereschi
authors.forename: Laura
authors.initials: L
authors.lastname: Del Bianco
authors.forename: Matteo
authors.initials: M
authors.lastname: Monami
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
authors.forename: Niccolò
authors.initials: N
authors.lastname: Marchionni
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D015906:Angioplasty, Balloon, Coronary; D015897:Comorbidity; D019992:Databases as Topic; D005260:Female; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D007558:Italy; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D015425:Myocardial Reperfusion; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome