title: [Management of ST-elevation myocardial infarction in the Umbria region: results from the observational prospective Umbria-STEMI registry].
abstract: BACKGROUND
  In the last few years, advances have been made in the diagnosis and management of ST-segment elevation myocardial infarction (STEMI). Recent guidelines have been developed to improve outcome of STEMI patients by implementation of the recommendations into clinical practice. In order to assess the disease burden, the treatment modalities and the mid-term outcome of STEMI in the Umbria region, Italy, we performed a prospective observational study of all patients hospitalized with a diagnosis of STEMI from October 14, 2006 to April 14, 2008 (Umbria-STEMI registry).
  
  
  METHODS
  All the medical emergency services (118) and all the emergency, internal medicine and cardiology departments were involved in the project. Three typologies of cardiology departments are operating in our region: a) intensive care units (ICUs) with percutaneous coronary intervention (PCI) facilities fully operating 24 h/day and 7 days/week (1 center), b) ICUs with PCI facilities operating 6 h/day and 5 days/week (2 centers); c) ICUs without PCI facilities (4 centers). The Umbria-STEMI health area includes about 850 000 inhabitants.
  
  
  RESULTS
  Overall, 868 patients (70% male, mean age 66.5 +/- 13.3 years) were enrolled. Patients with late presentation (> 12 h) or non-persistent ST-segment elevation (9.9%) were excluded. 86.7% of patients underwent reperfusion treatment: 45.9% with primary angioplasty and 40.8% with thrombolysis (64 of them had rescue angioplasty). Primary angioplasty was mainly performed in the hospital with PCI facilities operating 24 h/day. 104 patients with STEMI (13.3%) did not receive any type of coronary reperfusion therapy. In a logistic regression analysis, the direct admission to the hospital with fully operating PCI facilities was the strongest positive predictor of reperfusion therapy utilization, whereas the time delay, older age and TIMI risk index were negative predictors. The mean door-to-needle time for lytic therapy was 60 min, and the door-to-balloon time for primary angioplasty was 156 min. In-hospital mortality was 5.9%.
  
  
  CONCLUSIONS
  The Umbria-STEMI registry disclosed several discrepancies between guidelines-recommended treatments and their utilization in daily practice. Efforts should be made to reduce the delay from symptom onset to intervention.
authors.forename: Fabio
authors.initials: F
authors.lastname: Angeli
authors.forename: Maurizio
authors.initials: M
authors.lastname: Del Pinto
authors.forename: Gerardo
authors.initials: G
authors.lastname: Rasetti
authors.forename: Federico
authors.initials: F
authors.lastname: Patriarchi
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cocchieri
authors.forename: Sara
authors.initials: S
authors.lastname: Mandorla
authors.forename: Giorgio
authors.initials: G
authors.lastname: Maragoni
authors.forename: Giampiero
authors.initials: G
authors.lastname: Giordano
authors.forename: Claudio
authors.initials: C
authors.lastname: Giombolini
authors.forename: Paolo
authors.initials: P
authors.lastname: Verdecchia
authors.forename: Carlo
authors.initials: C
authors.lastname: Romagnoli
authors.forename: Claudio
authors.initials: C
authors.lastname: Cavallini
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries