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Care of acute myocardial infarction in the coronary care units of Piedmont in 2007: results from the ‘PRIMA_sweet’ region-wide survey

Steffenino, Giuseppe; Chinaglia, Alessandra; Noussan, Patrizia; Alciati, Mauro; Bongioanni, Sergio; Rolfo, Cristina; Soldà, Pier Luigi; Gnavi, Roberto; Picariello, Roberta; Orlando, Annaon behalf of the ‘PRIMAsweet’ investigators

Journal of Cardiovascular Medicine: May 2013 - Volume 14 - Issue 5 - p 354–363
doi: 10.2459/JCM.0b013e32835422f8
Original articles: Coronary artery disease
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Background 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.

Methods 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.

Results 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.

Conclusion 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: steffenino.g@ospedale.cuneo.it

Received 27 September, 2011

Revised 15 January, 2012

Accepted 7 March, 2012

© 2013 Italian Federation of Cardiology. All rights reserved.