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European Heart Journal Advance Access published online on July 10, 2008
European Heart Journal, doi:10.1093/eurheartj/ehn323
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

Clinical impact of an inter-hospital transfer strategy in patients with ST-elevation myocardial infarction undergoing primary angioplasty: the Emilia-Romagna ST-segment elevation acute myocardial infarction network

Antonio Manari1,*, Paolo Ortolani2, Paolo Guastaroba3, Gianni Casella4, Luigi Vignali5, Elisabetta Varani6, Giancarlo Piovaccari7, Vincenzo Guiducci1, Gianfranco Percoco8, Stefano Tondi9, Francesco Passerini10, Andrea Santarelli7 and Antonio Marzocchi2

1 Unità Operativa di Cardiologia Interventistica, Ospedale S. Maria Nuova, Viale Risorgimento n. 80, 42100 Reggio Emilia, Italy
2 Istituto di Cardiologia, Università di Bologna, Policlinico S. Orsola-Malpighi, Italy
3 Agenzia Sanitaria Regionale, Regione Emilia-Romagna Bologna, Italy
4 Divisione di Cardiologia, Ospedale Maggiore, Bologna, Italy
5 Divisione di Cardiologia, Azienda Ospedaliero-Universitaria, Parma, Italy
6 Unità Operativa di Cardiologia, Ospedale S. Maria delle Croci, Ravenna, Italy
7 Unità Operativa di Cardiologia, Ospedale degli Infermi, Rimini, Italy
8 Laboratorio di Emodinamica, Ospedale di Ferrara, Italy
9 Nuovo Ospedale S. Agostino, Modena, Italy
10 Divisione di Cardiologia, Ospedale Guglielmo da Saliceto, Piacenza, Italy

Received 25 September 2007; revised 13 June 2008; accepted 19 June 2008.

* Corresponding author. Tel: +39 0522295846, Fax: +39 0522296495, Email: manari.antonio{at}asmn.re.it

See page 1793 for the editorial comment on this article (doi:10.1093/eurheartj/ehn225)

Aims: This study sought to evaluate the impact of an inter-hospital transfer strategy on treatment times and in-hospital and 1 year cardiac mortality of patients with ST-segment elevation acute myocardial infarction (STEMI) undergoing primary percutaneous intervention (p-PCI) in the Italian region of Emilia-Romagna, where an efficient region-wide system for reperfusion has been established.

Methods and results: 3296 patients with STEMI, undergoing on-site p-PCI (2444 patients) (OS group) or p-PCI after inter-hospital transfer (852 patients) (T group) between 1 January 2004 and 30 June 2006 in the Italian region of Emilia-Romagna, were considered. During the study period, the number of patients undergoing p-PCI increased both for patients admitted to interventional centres and for those admitted to peripheral hospitals. At the same time, the proportion of patients with STEMI initially admitted to peripheral hospitals and not transferred and the door-to-balloon time delays of transfer patients decreased. In spite of longer door-to-balloon delay in the transfer group [112 min (86–147) vs. 71 min (46–104)], in-hospital cardiac mortality (OS 7.0 vs. T 5.4%, P = 0.10) did not significantly differ between the two groups. After multivariable adjustment, the transfer strategy was not associated with increased risk of in-hospital [odds ratio 0.956; 95% confidence interval (CI) 0.633–1.442] and 1 year (hazard ratio 0.817; 95% CI 0.617–1.085) cardiac mortality.

Conclusion: This study, concerning an established STEMI regional network, suggests that a strategy of inter-hospital transfer for p-PCI, when supported by an organized system of care, may be applied with rapid reperfusion times and favourable short- and long-term clinical outcomes.

Key Words: Myocardial infarction • Angioplasty • Registry • Network organization


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Eur. Heart J., August 1, 2008; 29(15): 1793 - 1794.
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