Implementation of a pre-hospital network favoring primary angioplasty in STEMI to reduce mortality: the Algarve Project.
OBJECTIVE
To analyze the impact of reperfusion by either primary percutaneous coronary intervention (PPCI) or fibrinolysis, and mortality rates of a pre-hospital fast-track network for treating patients with ST-elevation myocardial infarction (STEMI).


RESULTS
A pre-hospital network for STEMI patients, designated the Green Lane for Acute Myocardial Infarction (GL-AMI), has been implemented in the southern region of Portugal --the Algarve Project. We performed an observational study based on a prospective registry of 1338 patients admitted to Faro Hospital between 2004 and 2009, classified in two groups according to the method of admission: emergency department group (EDG) and GL-AMI group (GLG). More patients from GLG were reperfused (p < 0.0001). PPCI was the preferred method of reperfusion, 73.1% in GLG and 45.3% in EDG. Time delays were significantly shorter in GLG, except for pre-hospital delay: pre-hospital delay (p = 0.11); door-to-needle (p < 0.0001); door-to-balloon (p < 0.0001); and delay between symptoms and reperfusion (p < 0.0001). In-hospital mortality (4.3% vs 9.2%, p = 0.0007) and 6-month mortality (6.3% vs 13.8%, p < 0.0001) were significantly lower in GLG.


CONCLUSIONS
The Algarve Project significantly reduced the time delay between onset of symptoms and reperfusion, significantly increased the rate of reperfusion, and significantly reduced in-hospital and six-month mortality.
Department of Cardiology, Faro Hospital, Faro, Portugal. mvelosogomes@sapo.pt
Veloso
V
Gomes
Victor
V
Brandão
Jorge
J
Mimoso
Paula
P
Gago
Joana
J
Trigo
Walter
W
Santos
Nuno
N
Marques
Rui
R
Candeias
Salomé
S
Pereira
Vasco
V
Marques
Ana
A
Camacho
Ilídio
I
de Jesus
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D015912:Thrombolytic Therapy