Optimisation of therapeutic strategies for ST-segment elevation acute myocardial infarction: the impact of a territorial network on reperfusion therapy and mortality.
OBJECTIVE
To assess the clinical impact of a regional network for the treatment of ST-segment elevation myocardial infarction (STEMI).


METHODS
All patients with STEMI (n = 1823) admitted to any of the hospitals of an area with one million inhabitants during the year 2002 (n = 858)-that is, before the network was implemented, and in 2004 (n = 965), the year of full implementation of the network, were enrolled in this study. The primary evaluation was in-hospital mortality. Secondary outcomes included the incidence of major adverse cardiac and cerebrovascular events (MACCE), defined as death, myocardial infarction, stroke and coronary revascularisation procedures over 1-year follow-up.


RESULTS
Between 2002 and 2004, there was a major change in reperfusion strategy: primary angioplasty increased from 20.2% to 65.6% (p<0.001), fibrinolytic therapy decreased from 38.2% to 10.7% (p<0.001) and the rate of patients not undergoing reperfusion was reduced from 41.6% to 23.7% (p<0.001). In-hospital mortality decreased from 17.0% to 12.3% (p = 0.005), and this reduction was sustained at 1-year follow-up (23.9% in 2002 and 18.8% in 2004, p = 0.009). Similarly, the 1-year incidence of all MACCE was reduced from 39.5% in 2002 to 34.3% in 2004 (p = 0.01).


CONCLUSIONS
Organisation of a territorial network for STEMI is associated with increased rates of reperfusion therapy and reduction of in-hospital and 1-year mortality.
Saia
F
F
Institute of Cardiology, University of Bologna, Policlinico S Orsola-Malpighi (Pad 21), Bologna, Italy. francescosaia@hotmail.com
Marrozzini
C
C
Ortolani
P
P
Palmerini
T
T
Guastaroba
P
P
Cortesi
P
P
Pavesi
P C
PC
Gordini
G
G
Pancaldi
L G
LG
Taglieri
N
N
di Pasquale
G
G
Branzi
A
A
Marzocchi
A
A
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality* / Q000706:statistics & numerical data; D017023:Coronary Angiography / Q000401:mortality*; D003325:Coronary Care Units / Q000458:organization & administration; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy; D015912:Thrombolytic Therapy / Q000401:mortality* / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome