Ospedale Niguarda Cà Granda, Milan, Italy.
Eur Heart J Acute Cardiovasc Care. 2012 Sep;1(3):192-9. doi: 10.1177/2048872612453923.
Since 2001, the urban area of Milan has been operating a network among 23 cardiac care units, the 118 dispatch centre (national free number for medical emergencies), and the county government health agency called Group for Prehospital Cardiac Emergency.
In order to monitor the network activity, time to treatment, and clinical outcome, a periodic survey, called MOMI(2), was repeated two or three times a year. Each survey lasted 30 days and was repeated in comparable periods. Data were stratified for hospital admission mode. We collected data concerning 708 consecutive ST-elevation myocardial infarction (STEMI) patients (male 72.6%; mean age 64.4 years). In these six surveys, we observed a high rate of primary percutaneous coronary intervention (73.2%) and a mortality rate of 6.3%. Using advanced statistical models, we identified age, Killip class, and the symptom onset-to-balloon time as most relevant prognostic factors. Nonparametric test showed that the modality of hospital admittance was the most critical determinant of door-to-balloon time. 12-lead ECG tele-transmission and activation of a fast track directly to the catheterization laboratory are easy action to reduce time to treatment.
The experience of the Milan network for cardiac emergency shows how a network coordinating the community, rescue units, and hospitals in a complex urban area and making use of medical technology contributes to the health care of patients with STEMI.
自 2001 年以来，米兰市区一直在运营一个网络，该网络由 23 个心脏护理单位、118 调度中心（全国医疗急救免费号码）和县政府卫生机构（称为院前心脏急救小组）组成。
为了监测网络活动、治疗时间和临床结果，周期性调查（称为 MOMI(2)）每两年或三年重复两次或三次。每次调查持续 30 天，并在可比时期重复。数据按入院模式分层。我们收集了 708 例连续 ST 段抬高型心肌梗死（STEMI）患者（男性 72.6%；平均年龄 64.4 岁）的数据。在这六次调查中，我们观察到高比例的直接经皮冠状动脉介入治疗（73.2%）和死亡率为 6.3%。使用先进的统计模型，我们确定年龄、Killip 分级和症状发作至球囊时间是最重要的预后因素。非参数检验表明，入院方式是影响门球时间的最关键决定因素。12 导联心电图远程传输和直接激活快速通道到导管实验室是缩短治疗时间的简便措施。
米兰心脏急救网络的经验表明，一个协调社区、救援单位和复杂市区医院的网络，并利用医疗技术如何有助于 STEMI 患者的医疗保健。
