title: [The network for acute coronary syndromes in the metropolitan area of Cagliari (Italy): management of ST-elevation myocardial infarction, reperfusion time, and adherence to guidelines].
abstract: BACKGROUND
  An integrated network for the management of acute ST-elevation myocardial infarction (STEMI) allows a pre-hospital diagnosis and facilitates the best strategy to provide the most effective reperfusion therapy. This study aims to assess the network impact on timing and mode of reperfusion in the metropolitan area of Cagliari.
  
  
  METHODS
  From January 1, 2008 to December 31, 2010 all patients affected by STEMI with symptom onset <12h were enrolled. We evaluated modality of hospital access, reperfusion therapies, and time for avoidable delay. The first medical contact-to-balloon time (FMC-to-balloon) was compared between patients without ECG transmission (No-ECG group) and those with ECG transmission and direct transport to the cath-lab (Cath-Lab-ECG group) or the emergency room/intensive cardiac care unit (ER/ICCU-ECG group).
  
  
  RESULTS
  Out of 622 patients enrolled, 324 (52.1%) arrived to hospital by emergency medical systems. In this group a pre-hospital diagnosis was made in 79.3% of cases (n = 257); among them, 138 patients (53.7%) had a direct access to cath-lab, 99 to ICCU (38.5%), and 20 (7.8%) to ER. In the whole study population an urgent coronary angiography was performed in 612 patients (98.4%) and a primary percutaneous coronary intervention (p-PCI) in 589 (96.2%). In the Cath-Lab-ECG group the FMC-to-balloon was 89 ± 29 min (median 87 min, interquartile range 72-100), significantly lower than in the ER/ICCU-ECG group [122 ± 39 min (115 min)] and the No-ECG group [150 ± 54 min (139 min)] (p<0.01). A FMC-to-balloon ≤90 min was achieved in 66.4% of Cath-Lab-ECG patients, 22.1% of ER/ICCU-ECG patients, and 8.3% of No-ECG patients (Cath-Lab-ECG vs ER/ICCU-ECG, p<0.01).
  
  
  CONCLUSIONS
  Our results show that an integrated network provides a pre-hospital diagnosis in the majority of STEMI. However, only a direct transport to the cath-lab allows to achieve a FMC-to-balloon ≤90 min in a large proportion of patients. Out of this condition, adherence to guideline-recommended time of ≤90 min is significantly lower.
authors.affiliation: SC di Cardiologia-UTIC, AOG, Brotzu, Cagliari, Italy. giampaolo.scorcu@tin.it
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Scorcu
authors.forename: Luigi
authors.initials: L
authors.lastname: Meloni
authors.forename: Annarita
authors.initials: A
authors.lastname: Pilleri
authors.forename: Bruno
authors.initials: B
authors.lastname: Loi
authors.forename: Raimondo
authors.initials: R
authors.lastname: Pirisi
authors.forename: Francesco
authors.initials: F
authors.lastname: Sanna
authors.forename: Mauro
authors.initials: M
authors.lastname: Cadeddu
authors.forename: Emanuela
authors.initials: E
authors.lastname: Serra
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Sori
authors.forename: Daniela
authors.initials: D
authors.lastname: Boscarelli
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Iasiello
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Pinna
authors.forename: Maurizio
authors.initials: M
authors.lastname: Porcu
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000592:standards*; D011446:Prospective Studies; D013997:Time Factors; D014504:Urban Health