INTRODUCTION: Organization of regional systems of care (RSC) with an emphasis on pre-hospital triage and primary percutaneous coronary intervention (PCI) has been recommended to implement guidelines and improve clinical outcome in ST-segment elevation myocardial infarction (STEMI). PATIENTS AND METHODS: All STEMI patients (n = 1,823) admitted to any of the 13 hospitals of the province of Bologna, Italy, before (pre-RSC, n = 858) and after (RSC, n = 965) the implementation of a RSC were enrolled in the study. Primary evaluation was mortality. Secondary outcomes included death, myocardial infarction, stroke, and coronary revascularization procedures up to three-year follow-up. RESULTS: Among patients admitted <12 h from symptom onset, reperfusion was performed in 68.7% pre-RSC versus 89.8% RSC, P <0.001. Within the RSC, primary PCI became the main reperfusion treatment (34.5% pre-RSC versus 85.9% RSC; P <0.001 for both), and one-year mortality was lower (23.9% pre-RSC versus 18.8% RSC; P = 0.0015). At three-year, this advantage was maintained and actually increased (31.7% pre-RSC versus 24.8% RSC; P = 0.0031). Independent predictors of mortality at three-years were RSC, age, heart failure, cerebrovascular disease, renal disease, shock, peripheral vascular disease, and malignancies. CONCLUSIONS: In this study, RSC for the treatment of STEMI was associated with increased rates of reperfusion and reduction of long-term mortality.

Lower long-term mortality within a regional system of care for ST-elevation myocardial infarction / Saia F; Marrozzini C; Guastaroba P; Ortolani P; Palmerini T; Pavesi PC; Gordini G; Pancaldi LG; Taglieri N; Palma R; Pasquale G; Branzi A; Marzocchi A.. - In: ACUTE CARDIAC CARE. - ISSN 1748-2941. - STAMPA. - 12:(2010), pp. 42-50. [10.3109/17482941003732766]

Lower long-term mortality within a regional system of care for ST-elevation myocardial infarction.

SAIA, FRANCESCO;Palmerini T;GORDINI, GIOVANNI;TAGLIERI, NEVIO;BRANZI, ANGELO;
2010

Abstract

INTRODUCTION: Organization of regional systems of care (RSC) with an emphasis on pre-hospital triage and primary percutaneous coronary intervention (PCI) has been recommended to implement guidelines and improve clinical outcome in ST-segment elevation myocardial infarction (STEMI). PATIENTS AND METHODS: All STEMI patients (n = 1,823) admitted to any of the 13 hospitals of the province of Bologna, Italy, before (pre-RSC, n = 858) and after (RSC, n = 965) the implementation of a RSC were enrolled in the study. Primary evaluation was mortality. Secondary outcomes included death, myocardial infarction, stroke, and coronary revascularization procedures up to three-year follow-up. RESULTS: Among patients admitted <12 h from symptom onset, reperfusion was performed in 68.7% pre-RSC versus 89.8% RSC, P <0.001. Within the RSC, primary PCI became the main reperfusion treatment (34.5% pre-RSC versus 85.9% RSC; P <0.001 for both), and one-year mortality was lower (23.9% pre-RSC versus 18.8% RSC; P = 0.0015). At three-year, this advantage was maintained and actually increased (31.7% pre-RSC versus 24.8% RSC; P = 0.0031). Independent predictors of mortality at three-years were RSC, age, heart failure, cerebrovascular disease, renal disease, shock, peripheral vascular disease, and malignancies. CONCLUSIONS: In this study, RSC for the treatment of STEMI was associated with increased rates of reperfusion and reduction of long-term mortality.
2010
Lower long-term mortality within a regional system of care for ST-elevation myocardial infarction / Saia F; Marrozzini C; Guastaroba P; Ortolani P; Palmerini T; Pavesi PC; Gordini G; Pancaldi LG; Taglieri N; Palma R; Pasquale G; Branzi A; Marzocchi A.. - In: ACUTE CARDIAC CARE. - ISSN 1748-2941. - STAMPA. - 12:(2010), pp. 42-50. [10.3109/17482941003732766]
Saia F; Marrozzini C; Guastaroba P; Ortolani P; Palmerini T; Pavesi PC; Gordini G; Pancaldi LG; Taglieri N; Palma R; Pasquale G; Branzi A; Marzocchi A.
File in questo prodotto:
Eventuali allegati, non sono esposti

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/91056
 Attenzione

Attenzione! I dati visualizzati non sono stati sottoposti a validazione da parte dell'ateneo

Citazioni
  • ???jsp.display-item.citation.pmc??? 0
  • Scopus 12
  • ???jsp.display-item.citation.isi??? ND
social impact