title: Optimisation of therapeutic strategies for ST-segment elevation acute myocardial infarction: the impact of a territorial network on reperfusion therapy and mortality.
abstract: 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.
authors.affiliation: Institute of Cardiology, University of Bologna, Policlinico S Orsola-Malpighi (Pad 21), Bologna, Italy. francescosaia@hotmail.com
authors.forename: F
authors.initials: F
authors.lastname: Saia
authors.forename: C
authors.initials: C
authors.lastname: Marrozzini
authors.forename: P
authors.initials: P
authors.lastname: Ortolani
authors.forename: T
authors.initials: T
authors.lastname: Palmerini
authors.forename: P
authors.initials: P
authors.lastname: Guastaroba
authors.forename: P
authors.initials: P
authors.lastname: Cortesi
authors.forename: P C
authors.initials: PC
authors.lastname: Pavesi
authors.forename: G
authors.initials: G
authors.lastname: Gordini
authors.forename: L G
authors.initials: LG
authors.lastname: Pancaldi
authors.forename: N
authors.initials: N
authors.lastname: Taglieri
authors.forename: G
authors.initials: G
authors.lastname: di Pasquale
authors.forename: A
authors.initials: A
authors.lastname: Branzi
authors.forename: A
authors.initials: A
authors.lastname: Marzocchi
mesh_terms: 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