Copyright © 2003 by the European Society of Cardiology.
Regular Articles
Determinants of treatment strategies and survival in acute myocardial infarction: a population-based study in the Florence district, Italy
Results of the acute myocardial infarction Florence registry (AMI-Florence)1,,2
a Epidemiology Unit, Agenzia Regionale di Sanità della Toscana, via Vittorio Emanuele II 64, 50134 Florence, Italy
b Epidemiology Unit, Azienda Sanitaria di Firenze, via san Salvi 12 41, 50100 Florence, Italy
c Department of Critical Care Medicine and Surgery, Unit of Gerontology and Geriatric Medicine, University of Florence, and Azienda Ospedaliera Careggi, Via delle Oblate 4, 50141 Florence, Italy
d Cardiology Unit 1, Azienda Ospedaliera Careggi, Viale Pieraccini 17, 50139 Florence, Italy
e Department of Critical Care Medicine and Surgery, Unit of Internal Medicine and Cardiology, University of Florence, and Azienda Ospedaliera Careggi, Viale Morgagni 85, 50139 Florence, Italy
f Emergency Department, Azienda Ospedaliera Careggi, Viale Pieraccini 17, 50139 Florence, Italy
g Cardiology Unit, Santa Maria Nuova Hospital Azienda Sanitaria di Firenze, P.zza Santa Maria Nuova 1, 50122 Florence, Italy
h Cardiology Unit, Nuovo San Giovanni di Dio Hospital, Azienda Sanitaria di Firenze, via di Torregalli 3, 50100 Florence, Italy
i Medicine Unit 1, Santa Maria Annunziata Hospital, Azienda Sanitaria di Firenze, via dell‘Antella 58, 50011 Bagno a Ripoli, Italy
j Medicine Unit 2, Santa Maria Annunziata Hospital, Azienda Sanitaria di Firenze, via dell‘Antella 58, 50011 Bagno a Ripoli, Italy
* Corresponding author: Dr A. Barchielli, Azienda Sanitaria di Firenze, Epidemiology Unit, via S. Salvi 12, 50135 Florence, Italy. Tel.: +39-556263307; fax: +39-556263375.
E-mail address: epidemiologia{at}asf.toscana.it
Received 29 October 2002; revised 10 February 2003; accepted 3 April 2003
Aims The Florence Acute Myocardial Infarction Registry is a prospective, observational study aimed at identifying the determinants of use of primary PCI and of prognosis in patients with STE-AMI, in an unselected population-based setting.
Methods and results Nine hundred and thirty cases of STE-AMI (mean age: 70.5 years) were prospectively recorded. Factors associated with use of revascularization, or influencing survival were identified through multivariate analyses (respectively: logistic and Cox regression). Primary PCI was the preferred reperfusion therapy in the study district, with 50% of STE-AMI cases admitted within 24h, and 58% of those admitted within 12h from symptom onset treated; about 5% of patients undergone fibrinolysis (overall revascularization being 55% and 63%, respectively). Availability of PCI facilities at admission hospital was the strongest independent positive predictor of subsequent primary PCI. Advanced age, comorbidities, Killip class 3, delayed hospitalisation and other factors independently reduced the probability of receiving reperfusion. In the whole series, in-hospital mortality was 6.6% for revascularization and 15.6% for conservative therapy, 6-month mortality was 10.1% and 26.0% respectively. The independent, protective effect of primary PCI persisted at the multivariate analysis, being 44% the reduction in the risk of death at 6 months.
Conclusion In this unselected series of patients, primary PCI, routinely performed in high volume centres, achieved good results in terms of survival even outside the setting of a randomised clinical trial. However, the relatively high number of untreated subjects and the tendency to select less severe cases of AMI for reperfusion treatment confirm the need for an accurate reassessment of behavioural patterns in selecting patients for revascularization.
Key Words: STE-AMI • PCI • Population-based • Registry • Prognosis • Determinants of use
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