title: Primary percutaneous coronary intervention without on-site cardiac surgery backup in unselected patients with ST-segment-elevation myocardial infarction: the Rivoli ST-segment elevation myocardial infarction (RISTEMI) registry.
abstract: BACKGROUND
  Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for patients with ST-segment-elevation myocardial infarction (STEMI), but some concerns remain about its safety and efficacy in centers without on-site cardiac surgery (OCS).
  
  
  METHODS
  The Infermi Hospital in Rivoli, Italy, is a community hospital without OCS with a high volume catheterization laboratory (>800 PCI and >150 primary PCI per year), which provides a 24-hour primary PCI service to a population of 583.000 and is only 14 km far from the nearest OCS hospital. We analyzed clinical and procedural data, as well as 30-day outcome, of all STEMI patients treated by primary PCI within 12 hours from symptom onset.
  
  
  RESULTS
  From September 2001 to June 2010, 1302 patients with a suspect of STEMI underwent urgent coronary angiography. Of these, 1251 (96.1%), underwent primary PCI. A successful myocardial revascularization was achieved in 1172 patients (93.7%). Thirty-day mortality occurred in 7.1%. Multivariate predictors of 30-day mortality were: age ≥75 years (OR 3.96, p=0.0003), left ventricular ejection fraction ≤40% (OR 35.0, p=0.02), cardiogenic shock at presentation (OR 33.4, p<0.0001), anterior STEMI (OR 1.82, p=0.036) and total ischemic time ≤3 hours (OR 0.55, p=0.05).
  
  
  CONCLUSIONS
  Primary PCI is a reperfusion strategy feasible and effective in unselected high-risk STEMI patients even in hospitals without OCS with a high volume of routine and emergency interventional procedures.
authors: Department of Cardiology, Infermi Hospital, Rivoli, Italy. tomascard.tomassini@gmail.com
authors: Francesco
authors: F
authors: Tomassini
authors: Andrea
authors: A
authors: Gagnor
authors: Nicolò
authors: N
authors: Montali
authors: Vincenzo
authors: V
authors: Infantino
authors: Emanuele
authors: E
authors: Tizzani
authors: Paolo
authors: P
authors: Tizzani
authors: Gaetano Antonio
authors: GA
authors: Lanza
authors: Maria Rosa
authors: MR
authors: Conte
authors: Ferdinando
authors: F
authors: Varbella
mesh_terms: D000368:Aged; D006348:Cardiac Surgical Procedures; D016507:Cardiology Service, Hospital; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D004636:Emergency Service, Hospital; D005240:Feasibility Studies; D005260:Female; D006297:Health Services Accessibility; D006764:Hospitals, Community; D061847:Hospitals, High-Volume; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D016017:Odds Ratio; D018579:Patient Selection; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012384:Rome; D013997:Time Factors; D016896:Treatment Outcome