Marzocchi Antonio, Saia Francesco, Bolognese Leonardo, Tamburino Corrado, Giordano Arturo, Ramondo Angelo, Sangiorgi Giuseppe Massimo, Tomai Fabrizio, Cavallini Claudio, Sardella Gennaro, Cortesi Pietro, Di Pasquale Giuseppe, De Servi Stefano
Istituto di Cardiologia, Universita degli Studi, Policlinico S. Orsola-Malpighi, Bologna.
G Ital Cardiol (Rome). 2011 May;12(5):354-64. doi: 10.1714/643.7501.
The organization of a regional system of care (RSC) for ST-elevation myocardial infarction (STEMI) is recommended by the Italian Federation of Cardiology (FIC) and international guidelines in order to increase the number of patients treated with primary coronary angioplasty and, more in general, with reperfusion therapy, speed up the diagnostic and therapeutic processes, and ultimately improve the outcome.
The "RETE IMA WEB" survey was launched in 2007 from the Italian Society of Invasive Cardiology (SICI-GISE) in collaboration with the FIC, with the aim of evaluating the current state of RSC for STEMI in Italy. The personnel of the 118 Emergency System participated in the survey. Data collection was made using different electronic forms with access limited by personal passwords. We assessed the organization of the RSC together with local resource availability, with specific attention to the distance from a Hub center.
The survey ended in December 31, 2008. We censored 701 hospitals admitting STEMI patients, 157 (22.4%) with uninterrupted access (h24/7 days) to the catheterization laboratory (2.67 per million inhabitants). An operative network was present in 36/103 (35.9%) provinces, with important geographic variability. Among hospitals without a full-time primary angioplasty facility, only 46% was within a RSC. ECG was available in 72% of the national territory, telemedicine in 50%. Prehospital fibrinolysis was available in 16% of the country. Overall, 92.4% of the Italian population resides within 60 min of a Hub center.
In 2008, despite an adequate framework, the RSC for STEMI in Italy was heterogeneous and still suboptimal. Healthcare administrators, scientific societies and all operators involved in the process of care for STEMI should make efforts to implement current guidelines.
意大利心脏病学会联合会（FIC）和国际指南推荐建立ST段抬高型心肌梗死（STEMI）区域护理系统（RSC），以增加接受直接冠状动脉血管成形术治疗的患者数量，更广泛地说，增加接受再灌注治疗的患者数量，加快诊断和治疗过程，并最终改善治疗结果。
“RETE IMA WEB”调查于2007年由意大利介入心脏病学会（SICI-GISE）与FIC合作开展，旨在评估意大利STEMI的RSC现状。118个急救系统的人员参与了调查。数据收集使用不同的电子表格，通过个人密码限制访问。我们评估了RSC的组织情况以及当地资源可用性，特别关注与中心枢纽医院的距离。
调查于2008年12月31日结束。我们审查了701家收治STEMI患者的医院，其中157家（22.4%）可随时（每周7天，每天24小时）使用导管实验室（每百万居民中有2.67家）。103个省份中的36个（35.9%）存在手术网络，存在显著的地理差异。在没有全职直接血管成形术设施的医院中, 只有46%位于RSC内。72%的国土可进行心电图检查，50%可进行远程医疗。16%的地区可进行院前纤维蛋白溶解治疗。总体而言，92.4%的意大利人口居住在距离中心枢纽医院60分钟车程内。
2008年，尽管有适当的框架，但意大利STEMI的RSC仍存在异质性且仍未达到最佳状态。医疗保健管理人员、科学协会以及所有参与STEMI护理过程的操作人员应努力实施现行指南。
