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Acute coronary syndromes
Optimisation of therapeutic strategies for ST-segment elevation acute myocardial infarction: the impact of a territorial network on reperfusion therapy and mortality
  1. F Saia1,
  2. C Marrozzini1,
  3. P Ortolani1,
  4. T Palmerini1,
  5. P Guastaroba2,
  6. P Cortesi1,
  7. P C Pavesi3,
  8. G Gordini4,
  9. L G Pancaldi5,
  10. N Taglieri1,
  11. G di Pasquale3,
  12. A Branzi1,
  13. A Marzocchi1
  1. 1
    Istituto di Cardiologia, Università di Bologna, Policlinico S Orsola-Malpighi, Bologna, Italy
  2. 2
    Agenzia Sanitaria Regionale Regione Emilia-Romagna, Bologna, Italy
  3. 3
    Unità Operativa di Cardiologia, Ospedale Maggiore, Bologna, Italy
  4. 4
    Servizio Emergenza Territoriale 118 di Bologna, Ospedale Maggiore, Bologna, Italy
  5. 5
    Unità Operativa di Cardiologia, Ospedale di Bentivoglio, Bologna, Italy
  1. Dr F Saia, Institute of Cardiology, University of Bologna, Policlinico S Orsola-Malpighi (Pad 21), Via Massarenti 9, 40138 Bologna, Italy; francescosaia{at}hotmail.com

Abstract

Objective: To assess the clinical impact of a regional network for the treatment of ST-segment elevation myocardial infarction (STEMI).

Methods: All patients with STEMI (n = 1823) admitted to any of the hospitals of an area with one million inhabitants during the year 2002 (n = 858)—that is, before the network was implemented, and in 2004 (n = 965), the year of full implementation of the network, were enrolled in this study. The primary evaluation was in-hospital mortality. Secondary outcomes included the incidence of major adverse cardiac and cerebrovascular events (MACCE), defined as death, myocardial infarction, stroke and coronary revascularisation procedures over 1-year follow-up.

Results: Between 2002 and 2004, there was a major change in reperfusion strategy: primary angioplasty increased from 20.2% to 65.6% (p<0.001), fibrinolytic therapy decreased from 38.2% to 10.7% (p<0.001) and the rate of patients not undergoing reperfusion was reduced from 41.6% to 23.7% (p<0.001). In-hospital mortality decreased from 17.0% to 12.3% (p = 0.005), and this reduction was sustained at 1-year follow-up (23.9% in 2002 and 18.8% in 2004, p = 0.009). Similarly, the 1-year incidence of all MACCE was reduced from 39.5% in 2002 to 34.3% in 2004 (p = 0.01).

Conclusions: Organisation of a territorial network for STEMI is associated with increased rates of reperfusion therapy and reduction of in-hospital and 1-year mortality.

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Footnotes

  • Funding: Fondazione Fanti Melloni, and University of Bologna, Bologna, Italy.

  • Competing interests: None.

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