title: [Door-to-balloon time and in-hospital mortality in patients with ST-evaluation myocardial infarction: a network experience in a province in northwest Tuscany, Italy].
abstract: BACKGROUND
  A network system for ST-elevation myocardial infarction (STEMI) patients offers a quick diagnosis and a rapid transfer to a specialized center for primary percutaneous coronary intervention. The aim of our study was to evaluate the relationship between door-to-balloon time and in-hospital mortality in our network of STEMI patients.
  
  
  METHODS
  Our Hub & Spoke network in the province of Massa-Carrara in the northwest of Tuscany Region, Italy, began in April 2006. This program involved 5 Spoke and 1 Hub centers, 1 medical helicopter, 3 advanced life support ambulances with direct transmission of the ECG and vital parameters to our cath lab on call 24h a day for primary percutaneous coronary intervention. Data regarding clinical, echocardiographic and hemodynamic parameters, the door-to-balloon (DTB) time and their impact on mortality were analyzed.
  
  
  RESULTS
  Up to January 2008, 312 STEMI patients were enrolled (242 male, mean age 66.6 +/- 12.3 years). The DTB time was 93 min (79-117, 25th-75th percentile, respectively). The gold standard of a DTB < or = 90 min was reached in 47.1% of patients. In-hospital mortality was associated with a longer DTB time as compared to alive patients (92 vs 120 min, p < 0.03). Two geographic areas of our territory were considered: the coast and the mountain area. Patients from the coast (n = 238) had a DTB time lower than patients from the mountain area (89.5 vs 122.5 min, p < 0.0001), and the risk of in-hospital mortality was significantly and independently correlated with the increase in DTB time (p = 0.04). CONCLUSIONS; Our data confirm the correlation between DTB time and in-hospital mortality. More efforts are necessary to reduce the time to treatment and mortality rates.
authors.affiliation: Fondazione CNR-Regione Toscana "Gabriele Monasterio", Ospedale del Cuore G. Pasquinucci, Massa. uparadossi@ifc.cnr.it
authors.forename: Umberto
authors.initials: U
authors.lastname: Paradossi
authors.forename: Cataldo
authors.initials: C
authors.lastname: Palmieri
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Trianni
authors.forename: Marcello
authors.initials: M
authors.lastname: Ravani
authors.forename: Marco
authors.initials: M
authors.lastname: Vaghetti
authors.forename: Antonio
authors.initials: A
authors.lastname: Rizza
authors.forename: Jacopo
authors.initials: J
authors.lastname: Gianetti
authors.forename: Simona
authors.initials: S
authors.lastname: Cardullo
authors.forename: Hakim
authors.initials: H
authors.lastname: Chabane
authors.forename: Stefano
authors.initials: S
authors.lastname: Maffei
authors.forename: Sergio
authors.initials: S
authors.lastname: Berti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004630:Emergencies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D013997:Time Factors; D055815:Young Adult