Optimisation of therapeutic strategies for ST-segment elevation acute myocardial infarction: the impact of a territorial network on reperfusion therapy and mortality

Saia, Francesco; Marrozzini, Cinzia; Ortolani, Paolo; Palmerini, Tullio; Guastaroba, Paolo; Cortesi, Pietro; Pavesi, Pier Camillo; Gordini, Giovanni; Pancaldi, Leonardo Goffredo; Taglieri, Nevio; Pasquale, Giuseppe Di; Branzi, Angelo; Marzocchi, Antonío

doi:10.1136/hrt.2008.146738

Cited by 44 publications

(20 citation statements)

References 30 publications

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“…As indicated by our findings, such organisation of care increases accessibility of reperfusion therapy (by increasing the rate of primary PCI) among STEMI patients and reduces mortality in this patient population. Similarly to our study, Saia et al [14] showed that introduction of regional primary PCI network was associated with an increased rate of reperfusion therapy among STEMI patients by increasing the proportion of patients treated with primary PCI, while the rate of fibrinolytic therapy was reduced. Introduction of this treatment network was also associated with a mortality reduction.…”

Section: Discussionsupporting

confidence: 86%

Effect of introducing a regional 24/7 primary percutaneous coronary intervention service network on treatment outcomes in patients with ST segment elevation myocardial infarction

et al. 2015

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A b s t r a c tBackground: In patients with acute ST segment elevation myocardial infarction (STEMI), primary percutaneous coronary intervention (PCI) is the preferred reperfusion method over fibrinolysis, if it is performed in a timely fashion by an experienced team in a centre with on-site primary PCI service. Treatment delay due to patient transfer to the cardiac catheterisation laboratory is an important limitation of mechanical reperfusion in STEMI patients. Aim:To analyse treatment outcomes in STEMI patients hospitalised in a regional hospital in Tarnow before and after introduction of a 24/7 primary PCI service.Methods: Enrolment into the registry continued for 12 months before introduction of a 24/7 primary PCI service (Period I: 19.04.2004(Period I: 19.04. -19.04.2005) and 15 months after introduction of a 24/7 primary PCI service (Period II: 8.08.2005-19.10.2006). Overall, 226 STEMI patients were analysed, including 115 patients in Period I and 111 patients in Period II. STEMI patients in Period I received conservative treatment (n = 59), pharmacoinvasive treatment (a half dose of alteplase, a full dose of abciximab, and transfer to a 24/7 primary PCI reference centre: n = 32) or fibrinolysis with streptokinase (n = 24), while all patients in Period II underwent primary PCI on the first day of hospitalisation. Occurrence of cardiovascular deaths, non-fatal recurrent infarctions, and revascularisation with PCI or coronary artery bypass grafting was evaluated in the two groups during 1-year follow-up. Results:Reperfusion therapy was used in 48.7% of STEMI patients in Period I (pharmacoinvasive treatment in 27.8% and fibrinolysis in 20.9%), and all patients in Period II underwent primary PCI. In-hospital mortality among STEMI patients in Period I was significantly higher than in Period II (23.5% vs. 5.4%, p < 0.001), and it was 23.7% in patients managed conservatively. The hazard ratio for Period II compared to Period I was 0.14 (95% CI 0.03-0.62, p = 0.009). A benefit of invasive treatment was seen during 1 year of follow-up (mortality 26.1% in Period I vs. 9.0% in Period II, p = 0.001). Invasive treatment was also associated with a shorter hospital stay. Conclusions:Introduction of a 24/7 primary PCI regional service (STEMI network) led to improved accessibility of invasive diagnosis and treatment and increased reperfusion treatment rates, resulting in reduced in-hospital and 1-year mortality among STEMI patients.

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Section: Discussionsupporting

confidence: 86%

Effect of introducing a regional 24/7 primary percutaneous coronary intervention service network on treatment outcomes in patients with ST segment elevation myocardial infarction

et al. 2015

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“…Improvements in the door-to-balloon time in itself were also shown to be poorly correlated with acute outcomes in a report from the Get With The Guidelines programme. 21 This observation is consistent with the impressive absolute 6.5 and 5.7% reduction in acute mortality observed in the Wien and Bologna STEMI registries, 22,23 respectively, after a 21 and 18% increase in the rate of reperfusion had been achieved, mostly by primary PCI, much larger than expected on the sole basis of superiority of primary PCI over fibrinolysis, verified in meta-analysis of randomized controlled trials that demonstrated only a 2% absolute reduction in mortality. 24 Simply striving to achieve a higher use of reperfusion in population with STEMI may impact total mortality more than other initiatives (e.g.…”

Section: Discussionsupporting

confidence: 73%

The management of acute myocardial infarction in the cardiological intensive care units in Italy: the ‘BLITZ 4 Qualità’ campaign for performance measurement and quality improvement

Olivari

Steffenino

Savonitto

et al. 2012

European Heart Journal: Acute Cardiovascular Care

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Aim: To assess and promote compliance of Italian cardiological intensive care units (CCUs) with evidence-based guidelines for the management of acute myocardial infarction (MI). Methods and results:The process of diagnosis and treatment of MI was prospectively evaluated in 163 CCUs by use of 30 indicators during two enrolment phases, each followed by a feedback of both local and general performance. Overall, 5854 patients with ST-segment elevation MI (STEMI) and 5852 with non-ST-segment elevation MI (NSTEMI) were consecutively enrolled. The target for each indicator was defined as compliance with the relevant recommendations in ≥90% of suitable patients and it was met for nine (30%) and 10 (33.3%) indicators in the first and second phases, respectively. Regardless of target, a significant improvement in compliance was observed in the second phase in 10 out of 30 indicators (33.3%). Use of pre-hospital ECG, expedite delivery of reperfusion therapy, dosage of antithrombotic drugs, and non-pharmacological implementation of secondary prevention were often off target. Similar in-hospital mortality was observed in phases I and II, both in patients with STEMI (4.0 vs. 4.2%, p=0.79) and NSTEMI (1.8 vs. 2.4%, p=0.11). Overall, 30-day mortality were 5.7% for patients with STEMI and 3.4% with NSTEMI. Conclusions: Performance indicators can accurately weigh the whole process of diagnosis and treatment of patients with MI and monitor the improvements in the quality of care. In our large population of consecutive patients, satisfactory 30-day outcomes were observed despite suboptimal adherence to guidelines for some indicators of recognised prognostic relevance.

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“…Les dernières recommandations de l'ESC insistent sur la nécessité de créer des réseaux régionaux pour adapter ces algorithmes aux circonstances locales [8]. Ceux-ci permettraient une augmentation de la proportion de patients bénéficiant d'une reperfusion, une diminution des délais de reperfusion, et une diminution de la mortalité [9,10].…”

Section: Introductionunclassified

Reperfusion des infarctus aigus avec sus-décalage du segment ST dans le RENAU/RESURCOR : des recommandations à la pratique

Duraffourg¹,

Yayehd²,

Fourny³

et al. 2014

Annales de Cardiologie et d'Angéiologie

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Optimisation of therapeutic strategies for ST-segment elevation acute myocardial infarction: the impact of a territorial network on reperfusion therapy and mortality

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

Cited by 44 publications

References 30 publications

Effect of introducing a regional 24/7 primary percutaneous coronary intervention service network on treatment outcomes in patients with ST segment elevation myocardial infarction

Effect of introducing a regional 24/7 primary percutaneous coronary intervention service network on treatment outcomes in patients with ST segment elevation myocardial infarction

The management of acute myocardial infarction in the cardiological intensive care units in Italy: the ‘BLITZ 4 Qualità’ campaign for performance measurement and quality improvement

Reperfusion des infarctus aigus avec sus-décalage du segment ST dans le RENAU/RESURCOR : des recommandations à la pratique

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