Acute myocardial infarction - From territory to definitive treatment in an Italian province

Rationale, aims and objectives Early reperfusion is the key to therapeutic success in acutemyocardial infarction (AMI). The duration of the process is influenced by various factorswhich in most of the cases are not easily modifiable. The aim of this study is to analyseAMItreatment process duration to identify determining factors. The objective is to better exploittime intervals imposed by spatial distance from the hospital.Method One-year data regarding acute coronary syndromes with elevated ST segment forpatients presenting to Policlinico teaching hospital (Modena, Italy) have been studied.Patients were divided into two groups for hospital access: A – ambulance access toPoliclinico emergency room (ER); B – self-referral to ER.Results Atotal of 141 patients have undergone percutaneous transluminal coronary angioplastyfor AMI at Policlinico, 106 males, 35 females (58.1% males in group A, 82.7% in B,P 0.002), with an average age of 66.09 14.30 years in group A and 60.90 13.47 in B(P 0.047). Mean pre-hospital time for group A was 122.54 130.69 minutes and B171.49 353.60 (P 0.25), mean hospital time in group A was 196.03 67.66 andB 255.14 113.16 (P < 0.001), mean total time in group A was 318.56 146.91 and B426.63 382.01 (P 0.02).Discussion Data show that group B suffered on average a 108-minute delay from symptomsinsurgence to definitive treatment. The duration of hospital time plays more importantrole in this finding than distance from the medical facility. In fact, on the ambulancea medical crew starts the diagnostic and therapeutic process relieving ER from initialevaluation.