Angeli Fabio, Del Pinto Maurizio, Rasetti Gerardo, Patriarchi Federico, Cocchieri Maurizio, Mandorla Sara, Maragoni Giorgio, Giordano Giampiero, Giombolini Claudio, Verdecchia Paolo, Romagnoli Carlo, Cavallini Claudio
G Ital Cardiol (Rome). 2010 May;11(5):393-401.
In the last few years, advances have been made in the diagnosis and management of ST-segment elevation myocardial infarction (STEMI). Recent guidelines have been developed to improve outcome of STEMI patients by implementation of the recommendations into clinical practice. In order to assess the disease burden, the treatment modalities and the mid-term outcome of STEMI in the Umbria region, Italy, we performed a prospective observational study of all patients hospitalized with a diagnosis of STEMI from October 14, 2006 to April 14, 2008 (Umbria-STEMI registry).
All the medical emergency services (118) and all the emergency, internal medicine and cardiology departments were involved in the project. Three typologies of cardiology departments are operating in our region: a) intensive care units (ICUs) with percutaneous coronary intervention (PCI) facilities fully operating 24 h/day and 7 days/week (1 center), b) ICUs with PCI facilities operating 6 h/day and 5 days/week (2 centers); c) ICUs without PCI facilities (4 centers). The Umbria-STEMI health area includes about 850 000 inhabitants.
Overall, 868 patients (70% male, mean age 66.5 +/- 13.3 years) were enrolled. Patients with late presentation (> 12 h) or non-persistent ST-segment elevation (9.9%) were excluded. 86.7% of patients underwent reperfusion treatment: 45.9% with primary angioplasty and 40.8% with thrombolysis (64 of them had rescue angioplasty). Primary angioplasty was mainly performed in the hospital with PCI facilities operating 24 h/day. 104 patients with STEMI (13.3%) did not receive any type of coronary reperfusion therapy. In a logistic regression analysis, the direct admission to the hospital with fully operating PCI facilities was the strongest positive predictor of reperfusion therapy utilization, whereas the time delay, older age and TIMI risk index were negative predictors. The mean door-to-needle time for lytic therapy was 60 min, and the door-to-balloon time for primary angioplasty was 156 min. In-hospital mortality was 5.9%.
The Umbria-STEMI registry disclosed several discrepancies between guidelines-recommended treatments and their utilization in daily practice. Efforts should be made to reduce the delay from symptom onset to intervention.
在过去几年中，ST段抬高型心肌梗死（STEMI）的诊断和治疗取得了进展。最近制定了指南，通过将建议应用于临床实践来改善STEMI患者的预后。为了评估意大利翁布里亚地区STEMI的疾病负担、治疗方式和中期预后，我们对2006年10月14日至2008年4月14日期间所有诊断为STEMI住院的患者进行了一项前瞻性观察研究（翁布里亚-STEMI注册研究）。
所有医疗急救服务机构（118个）以及所有急诊科、内科和心脏科都参与了该项目。我们地区有三种类型的心脏科：a）配备经皮冠状动脉介入治疗（PCI）设施且每周7天、每天24小时全面运行的重症监护病房（ICU）（1个中心）；b）配备PCI设施且每周5天、每天6小时运行的ICU（2个中心）；c）没有PCI设施的ICU（4个中心）。翁布里亚-STEMI医疗区域约有85万居民。
总共纳入了868例患者（70%为男性，平均年龄66.5±13.3岁）。排除了就诊延迟（>12小时）或ST段抬高不持续的患者（9.9%）。86.7%的患者接受了再灌注治疗：45.9%接受了直接冠状动脉介入治疗，40.8%接受了溶栓治疗（其中64例接受了补救性血管成形术）。直接冠状动脉介入治疗主要在每周7天、每天24小时运行PCI设施的医院进行。104例STEMI患者（13.3%）未接受任何类型的冠状动脉再灌注治疗。在逻辑回归分析中，直接入住配备全面运行PCI设施的医院是再灌注治疗使用的最强阳性预测因素，而延迟时间、高龄和心肌梗死溶栓治疗（TIMI）风险指数是阴性预测因素。溶栓治疗的平均门至针时间为60分钟，直接冠状动脉介入治疗的门至球囊时间为156分钟。住院死亡率为5.9%。
翁布里亚-STEMI注册研究揭示了指南推荐治疗方法与其在日常实践中的应用之间存在若干差异。应努力减少从症状发作到干预的延迟。
