Regional disparities in the management and outcomes of ST-elevation myocardial infarction: an Italian analysis focusing on time-dependent reperfusion networks and in-hospital logistics.
Iginio Colaiori, Giuseppe Biondi-Zoccai, Luigi Spadafora, Marco Bernardi, Antonio Aloia, Marco Ancona, Gianfranco Aprigliano, Emanuele Barbato, Cesare Baldi, Carlo Briguori, Paolo Buja, Mauro Cadeddu, Gavino Casu, Alberto De Caterina, Francesco DE Felice, Ciro DE Simone, Luca Donazzan, Fabio Ferranti, Nicoletta Franco, Achille Gaspardone, Ervis Hiso, Massimo Leoncini, Angelo Leone, Stefano Lucreziotti, Massimo Mancone, Lucia Marinucci, Mauro Maioli, Matteo Montorfano, Salvatore Musarò, Tullio Niglio, Andrea Picchi, Arnaldo Poli, Gerlando Preti, Flavio L Ribichini, Andrea Rolandi, Enrico Romagnoli, Giuseppe M Sangiorgi, Federica Serino, Pierluigi Soldà, Gianluca Tiberti, Fabrizio Tomai, Francesco Tomassini, Fabrizio Ugo, Giovanni Esposito, Francesco Saia, Francesco Versaci
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引用次数: 0
Abstract
Background: Prompt reperfusion is critical for patients with ST-segment elevation myocardial infarction (STEMI) to improve outcomes. Yet, variability in regional healthcare delivery may influence treatment times and patient outcomes. We thus aimed at evaluating differences in management and outcomes of STEMI patients across Northern, Central, and Southern Italy, focusing on time-dependent reperfusion and in-hospital logistics.
Methods: A prospective observational study conducted from September 1st to 25th, 2023, including 554 STEMI patients treated at high-volume hub centers operating 24/7. Data were collected through structured surveys completed by catheterization laboratory directors across different Italian regions. Primary outcomes included door-to-balloon (DTB) time, time from symptom onset to balloon inflation, and regional disparities in pre- and post-PCI management. Secondary outcomes included in-hospital mortality, discharge destinations, and medication regimens.
Results: The median DTB time was consistent across regions (30 minutes; IQR: 20-50 minutes). Significant regional disparities were however noted in time from symptom onset to balloon inflation, with Southern and Island regions experiencing longer median times (180 minutes) compared to Central (170 minutes) and Northern (154 minutes) regions (P<0.01). We also found a significant reduction in DTB time associated with ECG teletransmission from ambulances (mean reduction of 25 minutes, P=0.03). In-hospital mortality rates were similar across regions (P=0.83).
Conclusions: This comprehensive nationwide analysis highlights significant regional disparities in the management and treatment timelines of STEMI patients in Italy. Despite these differences, in-hospital care was consistently timely across regions, suggesting that pre-hospital logistics critically influence overall treatment times. Enhanced pre-hospital ECG teletransmission could further optimize reperfusion times, potentially improving patient outcomes.
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Panminerva Medica publishes scientific papers on internal medicine. Manuscripts may be submitted in the form of editorials, original articles, review articles, case reports, special articles, letters to the Editor and guidelines. The journal aims to provide its readers with papers of the highest quality and impact through a process of careful peer review and editorial work. Duties and responsibilities of all the subjects involved in the editorial process are summarized at Publication ethics. Manuscripts are expected to comply with the instructions to authors which conform to the Uniform Requirements for Manuscripts Submitted to Biomedical Editors by the International Committee of Medical Journal Editors (ICMJE).
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