Comparison of primary angioplasty in rural and metropolitan areas within an integrated network.
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.
Giuliani
Gabriele
G
Invasive Cardiology 2, Careggi Hospital, Florence, Italy. gabriele_giuliani@tiscali.it
Bonechi
Francesco
F
Vecchio
Sabine
S
Biondi-Zoccai
Giuseppe G L
GG
Nieri
Massimiliano
M
Vittori
Guido
G
Spaziani
Gaia
G
Nassi
Franco
F
Chechi
Tania
T
Di Mario
Carlo
C
Zipoli
Andrea
A
Margheri
Massimo
M
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