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Optimization of Therapeutic Strategies for ST-Elevation Acute Myocardial Infarction: the Impact of a Territorial Network on Reperfusion Therapy and Mortality
  1. Francesco Saia (francescosaia{at}hotmail.com)
  1. Institute of Cardiology, Policlinico S.Orsola-Malpighi, University of Bologna, Italy
    1. Cinzia Marrozzini (cmarrozz{at}libero.it)
    1. Institute of Cardiology, Policlinico S.Orsola-Malpighi, University of Bologna, Italy
      1. Paolo Ortolani (paortol{at}tin.it)
      1. Institute of Cardiology, Policlinico S.Orsola-Malpighi, University of Bologna, Italy
        1. Tullio Palmerini (tulliopalmerini{at}hotmail.com)
        1. Institute of Cardiology, Policlinico S.Orsola-Malpighi, University of Bologna, Italy
          1. Paolo Guastaroba (pguastaroba{at}regione.emilia-romagna.it)
          1. Regional Health Care Agency of Emilia-Romagna, Italy
            1. Pietro Cortesi (piecorte{at}libero.it)
            1. Institute of Cardiology, Policlinico S.Orsola-Malpighi, University of Bologna, Italy
              1. Pier Camillo Pavesi (piercamillo.pavesi{at}ausl.bo.it)
              1. Unità Operativa di Cardiologia, Ospedale Maggiore, Bologna, Italy
                1. Giovanni Gordini (g.gordini{at}118er.it)
                1. Servizio Emergenza territoriale 118 di Bologna, Ospedale Maggiore, Italy
                  1. Leonardo G Pancaldi (leonardo.pancaldi{at}ausl.bo.it)
                  1. Unità Operativa di Cardiologia, Ospedale di Bentivoglio, Bologna, Italy
                    1. Nevio Taglieri (neviotaglieri{at}hotmail.it)
                    1. Institute of Cardiology, Policlinico S.Orsola-Malpighi, University of Bologna, Italy
                      1. Giuseppe Di Pasquale (anmco.dipasquale{at}ausl.bo.it)
                      1. Unità Operativa di Cardiologia, Ospedale Maggiore, Bologna, Italy
                        1. Angelo Branzi (dircard{at}med.unibo.it)
                        1. Institute of Cardiology, Policlinico S.Orsola-Malpighi, University of Bologna, Italy
                          1. Antonio Marzocchi (antonio.marzocchi{at}tin.it)
                          1. Institute of Cardiology, Policlinico S.Orsola-Malpighi, University of Bologna, Italy

                            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=1,823) admitted to any of the hospitals of a 1-million inhabitants area during the year 2002 (n=858), i.e. before the network was implemented, and in 2004 (n=965), 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<.001), fibrinolytic therapy decreased from 38.2% to 10.7% (p<.001), and the rate of patients not undergoing reperfusion was reduced from 41.6% to 23.7% (p<.001). In-hospital mortality decreased from 17.0% to 12.3% (p=.008), and this reduction was sustained at 1-year follow-up (23.9% in 2002 and 18.8% in 2004, p=.009). Similarly, the 1-year incidence of all MACCE was reduced from 39.5% in 2002 to 34.3% in 2004 (p=.01).

                            Conclusions: Organization 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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