The treatment of acute myocardial infarction (AMI), both with ST-segment elevation [ST-elevation myocardial infarction (STEMI)] and non-ST-segment elevation [non-ST-elevation myocardial infarction (NSTEMI)], is evolving in Piedmont, with an increase in interventional procedures and hub-and-spoke networks. This new region-wide survey provides updated assessment of the management of STEMI and unprecedented data on NSTEMI.
In 30 coronary care units in Piedmont, all patients with AMI symptoms of duration less than 48 h, between January and March 2007, were included.
Of 921 patients, 447 had STEMI and 474 NSTEMI. Diabetes was present in 35% and chronic kidney disease in 38%. Hospital mortality was 4.7% [95% confidence interval (CI) 3.3–6.1]: age 75 years or older, Killip class higher than 1 and known diabetes or abnormal blood glucose on admission were multivariate predictors. Thrombolysis and primary percutaneous transluminal coronary angioplasty (pPTCA) were performed in 17.6 and 53.1% of 391 patients, respectively, with STEMI of 12 h or less, and 29.3% had no reperfusion therapy, notably 52% of patients aged 75 years or older and 51% of those reaching non-24/24 h interventional centres. Mortality after pPTCA was 2.5% and onsite door-to-balloon time was less than 90 min in 67.5%. Overall mortality after STEMI was 5.4% (95% CI 3.2–7.6). In NSTEMI, use of antithrombotic treatments was extensive, but invasive treatment within 72 h was limited to 8% of patients in centres without interventional facilities and independent of patient's risk profile. Mortality after NSTEMI was 4.0% (95% CI 2.2–5.8) and was predicted by both the Global Registry of Acute Coronary Events risk score and diabetes.
There is room for improvement in the treatment of AMI in our region, with more extensive use of reperfusion therapy in STEMI, especially in the elderly, and early revascularization and optimal medical treatment in higher-risk NSTEMI.
aSSD Emodinamica, Dipartimento Cardiovascolare, AO S. Croce Cuneo
bDivisione Cardiologia, Ospedale M. Vittoria
cDivisione Cardiologia, Ospedale Giovanni Bosco, Torino
dDivisione Cardiologia, Ospedale Cardinal Massaia, Asti
eDivisione Cardiologia, Ospedale degli Infermi, Rivoli
fDivisione Cardiologia, Ospedale Civile, Ciriè
gDivisione Cardiologia, Ospedale degli Infermi, Biella
hServizio Sovrazonale di Epidemiologia ASL TO3
iAssessorato alla Tutela della Salute e Sanità, Regione Piemonte, Torino
*Present address: Divisione Cardiologia, Ospedale Mauriziano, Torino.
Correspondence to Giuseppe Steffenino, SSD Emodinamica, Dipartimento Cardiovascolare AO S. Croce, Via Coppino 26, 12100 Cuneo, Italy Tel: +39 0171 641011; e-mail: firstname.lastname@example.org
Received 27 September, 2011
Revised 15 January, 2012
Accepted 7 March, 2012