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

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.

Key Words::

• Myocardial infarction
• mortality
• reperfusion
• regional system of care

Acknowledgements

The present study (named CORI, costi e benefici delle strategie di riperfusione nell'infarto miocardico acuto con ST sopralivellato) is an outcome survey of the project of the Italian region Emilia-Romagna to establish a regional network for the treatment of ST-elevation acute myocardial infarction. Therefore, it represents the effort of a large number of clinicians and health care providers, that the authors should like to acknowledge for their efforts to deliver to the population the best treatment for acute myocardial infarction and for their precious help in data collection.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.