La gestione della fase iperacuta dell'infarto miocardico con sopraslivellamento del tratto ST nella Regione Lombardia (GestIMA)

Translated title of the contribution: Management of the hyperacute phase of ST-elevation myocardial infarction in the Lombardy Region (GestIMA)

Luigi Oltrona, Antonio Mafrici, Maurizio Marzegalli, Cesare Fiorentini, Roberto Pirola, Antonio Vincenti

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background. Recent international and national surveys on the management of ST-elevation myocardial infarction have described a number of crucial issues regarding the prehospital phase, the criteria to address patients to primary angioplasty, the organization of interhospital transfers. GestIMA is a perspective survey organized by the Lombardy Sections of the Italian Cardiology Societies (ANMCO and SIC) aimed to investigate the management of the acute phase of myocardial infarction in the Lombardy Region. Methods. Between October 15 and November 14, 2003, consecutive patients hospitalized for ST-elevation myocardial infarction in the coronary care units of 60 hospitals in Lombardy were enrolled into the study. Results. Among 612 patients (median age 67 years, interquartile range 56-76 years, 68% males, 43% with acute anterior myocardial infarction), 43% reached the hospital using the 118 emergency medical service, in 20% an ECG was recorded before arrival (reported in 47%), 1.5% were treated with thrombolysis and 1.0% with glycoprotein IIb/IIIa inhibitors before hospital admission. Sixty-eight percent of patients underwent a reperfusion treatment: 43% with primary angioplasty (6% facilitated), 25% with thrombolysis (18% of them had rescue angioplasty). Primary angioplasty was mainly performed in younger patients and in those directly admitted to centers equipped with interventional facilities. During the acute phase of myocardial infarction, 10% of patients arrived to the coronary care units from 39 peripheral hospitals without coronary care unit; 21% of patients had a secondary transport between hospitals with coronary care unit (47% for primary angioplasty). Conclusions. In the Lombardy Region, where a high rate of patients with ST-elevation myocardial infarction was treated with primary angioplasty in 2003, the 118 emergency medical service and the transmission of ECG by telephone are still underutilized. Moreover, the prehospital pharmacological treatment, the prehospital triage of patients to address to primary angioplasty and the organization of secondary transfer need to be improved.

Original languageItalian
Pages (from-to)489-497
Number of pages9
JournalItalian Heart Journal Supplement
Volume6
Issue number8
Publication statusPublished - Aug 2005

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Angioplasty
Coronary Care Units
Myocardial Infarction
Emergency Medical Services
Electrocardiography
ST Elevation Myocardial Infarction
Platelet Glycoprotein GPIIb-IIIa Complex
Triage
Cardiology
Telephone
Reperfusion
Organizations
Pharmacology
Therapeutics

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

La gestione della fase iperacuta dell'infarto miocardico con sopraslivellamento del tratto ST nella Regione Lombardia (GestIMA). / Oltrona, Luigi; Mafrici, Antonio; Marzegalli, Maurizio; Fiorentini, Cesare; Pirola, Roberto; Vincenti, Antonio.

In: Italian Heart Journal Supplement, Vol. 6, No. 8, 08.2005, p. 489-497.

Research output: Contribution to journalArticle

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title = "La gestione della fase iperacuta dell'infarto miocardico con sopraslivellamento del tratto ST nella Regione Lombardia (GestIMA)",
abstract = "Background. Recent international and national surveys on the management of ST-elevation myocardial infarction have described a number of crucial issues regarding the prehospital phase, the criteria to address patients to primary angioplasty, the organization of interhospital transfers. GestIMA is a perspective survey organized by the Lombardy Sections of the Italian Cardiology Societies (ANMCO and SIC) aimed to investigate the management of the acute phase of myocardial infarction in the Lombardy Region. Methods. Between October 15 and November 14, 2003, consecutive patients hospitalized for ST-elevation myocardial infarction in the coronary care units of 60 hospitals in Lombardy were enrolled into the study. Results. Among 612 patients (median age 67 years, interquartile range 56-76 years, 68{\%} males, 43{\%} with acute anterior myocardial infarction), 43{\%} reached the hospital using the 118 emergency medical service, in 20{\%} an ECG was recorded before arrival (reported in 47{\%}), 1.5{\%} were treated with thrombolysis and 1.0{\%} with glycoprotein IIb/IIIa inhibitors before hospital admission. Sixty-eight percent of patients underwent a reperfusion treatment: 43{\%} with primary angioplasty (6{\%} facilitated), 25{\%} with thrombolysis (18{\%} of them had rescue angioplasty). Primary angioplasty was mainly performed in younger patients and in those directly admitted to centers equipped with interventional facilities. During the acute phase of myocardial infarction, 10{\%} of patients arrived to the coronary care units from 39 peripheral hospitals without coronary care unit; 21{\%} of patients had a secondary transport between hospitals with coronary care unit (47{\%} for primary angioplasty). Conclusions. In the Lombardy Region, where a high rate of patients with ST-elevation myocardial infarction was treated with primary angioplasty in 2003, the 118 emergency medical service and the transmission of ECG by telephone are still underutilized. Moreover, the prehospital pharmacological treatment, the prehospital triage of patients to address to primary angioplasty and the organization of secondary transfer need to be improved.",
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AU - Mafrici, Antonio

AU - Marzegalli, Maurizio

AU - Fiorentini, Cesare

AU - Pirola, Roberto

AU - Vincenti, Antonio

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N2 - Background. Recent international and national surveys on the management of ST-elevation myocardial infarction have described a number of crucial issues regarding the prehospital phase, the criteria to address patients to primary angioplasty, the organization of interhospital transfers. GestIMA is a perspective survey organized by the Lombardy Sections of the Italian Cardiology Societies (ANMCO and SIC) aimed to investigate the management of the acute phase of myocardial infarction in the Lombardy Region. Methods. Between October 15 and November 14, 2003, consecutive patients hospitalized for ST-elevation myocardial infarction in the coronary care units of 60 hospitals in Lombardy were enrolled into the study. Results. Among 612 patients (median age 67 years, interquartile range 56-76 years, 68% males, 43% with acute anterior myocardial infarction), 43% reached the hospital using the 118 emergency medical service, in 20% an ECG was recorded before arrival (reported in 47%), 1.5% were treated with thrombolysis and 1.0% with glycoprotein IIb/IIIa inhibitors before hospital admission. Sixty-eight percent of patients underwent a reperfusion treatment: 43% with primary angioplasty (6% facilitated), 25% with thrombolysis (18% of them had rescue angioplasty). Primary angioplasty was mainly performed in younger patients and in those directly admitted to centers equipped with interventional facilities. During the acute phase of myocardial infarction, 10% of patients arrived to the coronary care units from 39 peripheral hospitals without coronary care unit; 21% of patients had a secondary transport between hospitals with coronary care unit (47% for primary angioplasty). Conclusions. In the Lombardy Region, where a high rate of patients with ST-elevation myocardial infarction was treated with primary angioplasty in 2003, the 118 emergency medical service and the transmission of ECG by telephone are still underutilized. Moreover, the prehospital pharmacological treatment, the prehospital triage of patients to address to primary angioplasty and the organization of secondary transfer need to be improved.

AB - Background. Recent international and national surveys on the management of ST-elevation myocardial infarction have described a number of crucial issues regarding the prehospital phase, the criteria to address patients to primary angioplasty, the organization of interhospital transfers. GestIMA is a perspective survey organized by the Lombardy Sections of the Italian Cardiology Societies (ANMCO and SIC) aimed to investigate the management of the acute phase of myocardial infarction in the Lombardy Region. Methods. Between October 15 and November 14, 2003, consecutive patients hospitalized for ST-elevation myocardial infarction in the coronary care units of 60 hospitals in Lombardy were enrolled into the study. Results. Among 612 patients (median age 67 years, interquartile range 56-76 years, 68% males, 43% with acute anterior myocardial infarction), 43% reached the hospital using the 118 emergency medical service, in 20% an ECG was recorded before arrival (reported in 47%), 1.5% were treated with thrombolysis and 1.0% with glycoprotein IIb/IIIa inhibitors before hospital admission. Sixty-eight percent of patients underwent a reperfusion treatment: 43% with primary angioplasty (6% facilitated), 25% with thrombolysis (18% of them had rescue angioplasty). Primary angioplasty was mainly performed in younger patients and in those directly admitted to centers equipped with interventional facilities. During the acute phase of myocardial infarction, 10% of patients arrived to the coronary care units from 39 peripheral hospitals without coronary care unit; 21% of patients had a secondary transport between hospitals with coronary care unit (47% for primary angioplasty). Conclusions. In the Lombardy Region, where a high rate of patients with ST-elevation myocardial infarction was treated with primary angioplasty in 2003, the 118 emergency medical service and the transmission of ECG by telephone are still underutilized. Moreover, the prehospital pharmacological treatment, the prehospital triage of patients to address to primary angioplasty and the organization of secondary transfer need to be improved.

KW - Angioplasty, primary

KW - Myocardial infarction

KW - ST-segment elevation

KW - Thrombolysis

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