Zanini Roberto, Lettieri Corrado, Romano Michele, Buffoli Francesca, Izzo Antonio, Schiavone Giorgio, Baccaglioni Nicola, Aroldi Marco, Ferrari Mariarosa
Dipartimento di Cardiologia, Azienda Ospedaliera "Carlo Poma", Mantova.
Ital Heart J Suppl. 2003 Oct;4(10):838-49.
Since June 2001, in the province of Mantova, we have been carrying out a program for the management of acute myocardial infarction based on early assessment of the patients' risk profile, on telematic connection among care centers and on optimization of in- and out-of-hospital critical pathways for the access to care.
Our network provides connection among the following centers: advanced life support ambulances, 7 hospitals, 3 coronary care units, 1 cath lab on call 24 hours a day for primary angioplasty, 1 thoracic surgery division. This program, through its strong telematic platform, allows early assessment of myocardial infarction, and provides primary angioplasty to all high-risk patients, being fibrinolytic treatment reserved only to the low-risk patients admitted in peripheral hospitals.
Two hundred and twenty patients with acute myocardial infarction were treated with angioplasty; 179 (81%) patients underwent primary angioplasty, 26 (12%) patients facilitated angioplasty and 15 patients (7%) rescue angioplasty; 121 patients (55%) were first admitted in the Mantova hospital, 65 patients (30%) were referred to Mantova from peripheral hospitals and 34 patients (15%) were directly transported to the cath lab by advanced life support ambulances. Procedural success was obtained in 98% of cases, with 05% intraprocedural mortality. In-hospital mortality was 55%, while mortality of cardiogenic shock patients was 36%. Recurrence of acute myocardial infarction occurred in 1% and major bleeding in 2.2% of patients. One patient with cardiogenic shock died during transport. Mean door-to-balloon time was 73 min with 39% reduction in the second period of recruitment after telematic connection.
This program, developed in the setting of a provincial network for the management of acute myocardial infarction, provided primary angioplasty to all high-risk patients, with a high procedural success rate. Within a few months, time to treatment was minimized by the employment of telematic facilities.
自2001年6月起，在曼托瓦省，我们一直在开展一项急性心肌梗死管理项目，该项目基于对患者风险状况的早期评估、护理中心之间的远程连接以及优化院内和院外获得护理的关键路径。
我们的网络连接了以下中心：高级生命支持救护车、7家医院、3个冠心病监护病房、1个每天24小时待命进行直接冠状动脉介入治疗的导管室、1个胸外科。该项目通过其强大的远程平台，能够对心肌梗死进行早期评估，并为所有高危患者提供直接冠状动脉介入治疗，仅将溶栓治疗留给外周医院收治的低危患者。
220例急性心肌梗死患者接受了血管成形术治疗；179例（81%）患者接受了直接冠状动脉介入治疗，26例（12%）患者接受了辅助血管成形术，15例（7%）患者接受了补救血管成形术；121例（55%）患者首先入住曼托瓦医院，65例（30%）患者从外周医院转诊至曼托瓦，34例（15%）患者由高级生命支持救护车直接转运至导管室。98%的病例手术成功，术中死亡率为0.5%。院内死亡率为5.5%，而心源性休克患者的死亡率为36%。急性心肌梗死复发率为1%，大出血发生率为2.2%。1例心源性休克患者在转运过程中死亡。平均门球时间为73分钟，在远程连接后的第二个招募期减少了39%。
该项目在省级急性心肌梗死管理网络中开展，为所有高危患者提供了直接冠状动脉介入治疗，手术成功率高。在几个月内，通过使用远程设备将治疗时间缩短到了最短。
