title: Impact of a territorial ST-segment elevation myocardial infarction network on prognosis of patients with out-of-hospital cardiac arrest.
abstract: BACKGROUND
  We sought to assess the effect of a territorial system of care for ST-elevation myocardial infarction (STEMI) on the outcome of out-of-hospital cardiac arrest (OOHCA).
  
  
  METHODS
  We enrolled 720 patients who experienced a witnessed OOHCA of presumed cardiac origin during a four-year period in an area with a STEMI network and for whom resuscitation was attempted.
  
  
  RESULTS
  Overall, 242 (33.6%) patients had return of spontaneous circulation (ROSC), 645 (90%) died before discharge. We observed a trend toward decreased overall mortality for OOHCA between the years 2004 and 2007, both in the entire population and in patients with ROSC (2004=94%; 2005=89%; 2006=85%; 2007=89%; P=0.064; 2004=81%; 2005=69%; 2006=65%; 2007=60%; P=0.076, respectively). On multivariable analysis, age, crew-witnessed arrest and presence of shockable rhythm were independent predictors of mortality. Patients who experienced OOHCA in the year 2006 (OR=0.47; 95% CI: 0.21-1.05; P=0.07) and 2007 (OR=0.51; 95% CI: 0.23-1.12; P=0.09) showed a strong trend toward decreased risk of mortality compared to year 2004. In patients with ROSC, the year 2007 was associated with a significant lower risk of mortality compared to year 2004 (OR=0.38; 95% CI: 0.15-0.96; P=0.04).
  
  
  CONCLUSIONS
  Implementation of a territorial network of care for STEMI appears to be associated with reduced mortality OOHCA patients.
authors: Istituto di Cardiologia, Università di Bologna, Policlinico S. Orsola-Malpighi, Italy. neviotaglieri@hotmail.it
authors: Nevio
authors: N
authors: Taglieri
authors: Francesco
authors: F
authors: Saia
authors: Valerio
authors: V
authors: Lanzillotti
authors: Marrozzini
authors: Roberto
authors: R
authors: Faccioli
authors: Bruno
authors: B
authors: Iarussi
authors: Paolo
authors: P
authors: Ortolani
authors: Tullio
authors: T
authors: Palmerini
authors: Pietro
authors: P
authors: Cortesi
authors: Giovanni
authors: G
authors: Gordini
authors: Pamela
authors: P
authors: Gallo
authors: Angelo
authors: A
authors: Branzi
authors: Antonio
authors: A
authors: Marzocchi
mesh_terms: D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000592:standards*; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000517:prevention & control*; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality / Q000517:prevention & control*; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D012041:Regional Medical Programs / Q000458:organization & administration*; D015996:Survival Rate