title: Comparison of primary angioplasty in rural and metropolitan areas within an integrated network.
abstract: OBJECTIVE
  To compare reperfusion times and in-hospital outcome of patients with STEMI treated with primary percutaneous coronary intervention (PCI) in a teaching hospital (TH) with or without inter-hospital transfer and in community hospitals.
  
  
  RESULTS
  We performed a retrospective analysis of 536 patients with STEMI treated between January 2005 and December 2006 with primary PCI. Three groups were identified. A: 207 patients presented to the TH. B: 121 patients transferred to TH from metropolitan area hospitals (MAH). C: 208 patients presented in two rural area hospitals (RAH) with primary PCI capability. Baseline characteristics were similar. Door-to-balloon (DtB) times were significantly (p<0.001) higher in group B (median 120, range 90-180 min) both compared to group A (median 60, range 45-90 min) and C (median 73, range 55-99 min). In group B 79,5% of patients present a DtB > 90 min. In-hospital mortality was 4.9%, 3.3% and 4.3% respectively in group A, B and C without significant differences.
  
  
  CONCLUSIONS
  The expansion of primary PCI to RAH achieves reperfusion delays similar to that of patients admitted to TH. Transferred patients present very higher DtB when compared to patients treated on-site. In-hospital outcome are similar but further studies are warranted.
authors.affiliation: Invasive Cardiology 2, Careggi Hospital, Florence, Italy. gabriele_giuliani@tiscali.it
authors.forename: Gabriele
authors.initials: G
authors.lastname: Giuliani
authors.forename: Francesco
authors.initials: F
authors.lastname: Bonechi
authors.forename: Sabine
authors.initials: S
authors.lastname: Vecchio
authors.forename: Giuseppe G L
authors.initials: GG
authors.lastname: Biondi-Zoccai
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Nieri
authors.forename: Guido
authors.initials: G
authors.lastname: Vittori
authors.forename: Gaia
authors.initials: G
authors.lastname: Spaziani
authors.forename: Franco
authors.initials: F
authors.lastname: Nassi
authors.forename: Tania
authors.initials: T
authors.lastname: Chechi
authors.forename: Carlo
authors.initials: C
authors.lastname: Di Mario
authors.forename: Andrea
authors.initials: A
authors.lastname: Zipoli
authors.forename: Massimo
authors.initials: M
authors.lastname: Margheri
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D003327:Coronary Disease / Q000453:epidemiology / Q000628:therapy*; D019033:Delivery of Health Care, Integrated / Q000706:statistics & numerical data; D005260:Female; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006780:Hospitals, Rural / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000706:statistics & numerical data; D012189:Retrospective Studies