title: Shifting from pharmacological to systematic mechanical reperfusion therapy for acute myocardial infarction via a cooperating network: impact on reperfusion rate and in-hospital mortality.
abstract: BACKGROUND
  Primary percutaneous transluminal coronary angioplasty is the preferred reperfusion strategy for acute ST-elevation myocardial infarction in selected settings. Limited data are available about the clinical impact of the implementation of a systematic primary angioplasty infarct reperfusion program in the real world.
  
  
  RESULTS
  We organized a comprehensive district network allowing the coordinated and timely transfer of patients with acute ST-elevation myocardial infarction to the hub hospital with catheterization facilities in order to expand the use of mechanical reperfusion. Implementation of the network resulted in increased numbers of patients receiving reperfusion therapies (from 57.5% to 74.1%; P < 0.001). In addition, the proportion of elderly individuals (those aged > or = 75 years) who received a reperfusion therapy significantly increased (from 25.7% to 66.3%; P < 0.001). Accordingly, the proportion of patients not receiving reperfusion therapy dropped from 42.5% to 25.9%. Primary percutaneous transluminal coronary angioplasty usage increased from 24.5% to 73.1% (P < 0.001). As a consequence, in-hospital mortality decreased from 13.5% before establishment of the network to 6.0% (P = 0.016), and major adverse cardiac events decreased from 17.5% to 7.8% (P = 0.005).
  
  
  CONCLUSIONS
  Implementation of a systematic primary angioplasty infarct reperfusion program improves reperfusion rate and reduces in-hospital mortality and total major adverse cardiovascular events.
authors.affiliation: Department of Cardiovascular Diseases, Azienda Ospedaliera Arezzo, Arezzo, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Falsini
authors.forename: Francesco
authors.initials: F
authors.lastname: Liistro
authors.forename: Kenneth
authors.initials: K
authors.lastname: Ducci
authors.forename: Paolo
authors.initials: P
authors.lastname: Angioli
authors.forename: Silvia
authors.initials: S
authors.lastname: Baldassarre
authors.forename: Alessandra
authors.initials: A
authors.lastname: Sabini
authors.forename: Antonio
authors.initials: A
authors.lastname: Burali
authors.forename: Leonardo
authors.initials: L
authors.lastname: Bolognese
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002300:Cardiac Care Facilities / Q000458:organization & administration*; D003657:Decision Making; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods / Q000706:statistics & numerical data*; D011379:Prognosis; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods / Q000706:statistics & numerical data*; D013997:Time Factors
chemical_list: D005343:Fibrinolytic Agents