title: Acute myocardial infarction--from territory to definitive treatment in an Italian province.
abstract: OBJECTIVE
  Early reperfusion is the key to therapeutic success in acute myocardial infarction (AMI). The duration of the process is influenced by various factors which in most of the cases are not easily modifiable. The aim of this study is to analyse AMI treatment process duration to identify determining factors. The objective is to better exploit time intervals imposed by spatial distance from the hospital.
  
  
  METHODS
  One-year data regarding acute coronary syndromes with elevated ST segment for patients presenting to Policlinico teaching hospital (Modena, Italy) have been studied. Patients were divided into two groups for hospital access: A - ambulance access to Policlinico emergency room (ER); B - self-referral to ER.
  
  
  RESULTS
  A total of 141 patients have undergone percutaneous transluminal coronary angioplasty for AMI at Policlinico, 106 males, 35 females (58.1% males in group A, 82.7% in B, P 0.002), with an average age of 66.09 ± 14.30 years in group A and 60.90 ± 13.47 in B (P 0.047). Mean pre-hospital time for group A was 122.54 ± 130.69 minutes and B 171.49 ± 353.60 (P 0.25), mean hospital time in group A was 196.03 ± 67.66 and B 255.14 ± 113.16 (P<0.001), mean total time in group A was 318.56 ± 146.91 and B 426.63 ± 382.01 (P 0.02).
  
  
  CONCLUSIONS
  Data show that group B suffered on average a 108-minute delay from symptoms insurgence to definitive treatment. The duration of hospital time plays more important role in this finding than distance from the medical facility. In fact, on the ambulance a medical crew starts the diagnostic and therapeutic process relieving ER from initial evaluation.
authors.affiliation: Anaesthesia and Intensive Care, University of Modena and Reggio Emilia, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Giuliani
authors.forename: Sara
authors.initials: S
authors.lastname: Lazzerotti
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Fantini
authors.forename: Elisa
authors.initials: E
authors.lastname: Guerri
authors.forename: Carlo
authors.initials: C
authors.lastname: Serantoni
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Modena
authors.forename: Alberto
authors.initials: A
authors.lastname: Barbieri
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000552:Ambulances; D017598:Efficiency, Organizational; D005260:Female; D006297:Health Services Accessibility; D006784:Hospitals, Teaching; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D013997:Time Factors; D013996:Time and Motion Studies