Lower long-term mortality within a regional system of care for ST-elevation myocardial infarction.
BACKGROUND
Organization of regional systems of care (RSC) with an emphasis on pre-hospital triage and primary percutaneous coronary intervention (PCI) has been recommended to implement guidelines and improve clinical outcome in ST-segment elevation myocardial infarction (STEMI).


METHODS
All STEMI patients (n = 1,823) admitted to any of the 13 hospitals of the province of Bologna, Italy, before (pre-RSC, n = 858) and after (RSC, n = 965) the implementation of a RSC were enrolled in the study. Primary evaluation was mortality. Secondary outcomes included death, myocardial infarction, stroke, and coronary revascularization procedures up to three-year follow-up.


RESULTS
Among patients admitted <12 h from symptom onset, reperfusion was performed in 68.7% pre-RSC versus 89.8% RSC, P <0.001. Within the RSC, primary PCI became the main reperfusion treatment (34.5% pre-RSC versus 85.9% RSC; P <0.001 for both), and one-year mortality was lower (23.9% pre-RSC versus 18.8% RSC; P = 0.0015). At three-year, this advantage was maintained and actually increased (31.7% pre-RSC versus 24.8% RSC; P = 0.0031). Independent predictors of mortality at three-years were RSC, age, heart failure, cerebrovascular disease, renal disease, shock, peripheral vascular disease, and malignancies.


CONCLUSIONS
In this study, RSC for the treatment of STEMI was associated with increased rates of reperfusion and reduction of long-term mortality.
Saia
Francesco
F
Istituto di Cardiologia, Università di Bologna, Policlinico S. Orsola-Malpighi, Italy. francescosaia@hotmail.com <francescosaia@hotmail.com>
Marrozzini
Cinzia
C
Guastaroba
Paolo
P
Ortolani
Paolo
P
Palmerini
Tullio
T
Pavesi
Pier Camillo
PC
Gordini
Giovanni
G
Pancaldi
Leonardo G
LG
Taglieri
Nevio
N
Palma
Rossana de
Rd
Pasquale
Giuseppe di
Gd
Branzi
Angelo
A
Marzocchi
Antonio
A
D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D012041:Regional Medical Programs / Q000458:organization & administration*; D015996:Survival Rate; D015912:Thrombolytic Therapy; D016896:Treatment Outcome