Reperfusion therapy and door-to-balloon time among ST-elevation Myocardial Infarction patients in Northern Italy

Aim. Guidelines recommend early reperfusion therapy for patients with ST-elevation Myocardial Infarction (ST-e MI). We aim to evaluate the adherence to guidelines in Northern Italy in 2007-2008. Methods. The study population comprises the 35-79 years old residents in the Varese Province. From the regional Hospital Discharge Record database we identified n=1229 hospitalizations with a main discharge code ICD-IX 410.xx not 410.7x occurring in the 17 surveyed hospitals. Clinical information was available for n=1221 events; particular attention was dedicated to the time of symptoms onset, ER arrival, first ECG, fibrinolytic therapy and Percutaneous Coronary Intervention (PCI) execution. Finally, n=49 non acute events were excluded, leaving a final number of n=1172 hospitalizations. The main performance measure is the proportion of patients receiving reperfusion therapy (either fibrinolysis or PCI) among those without documented contraindications to therapy. We further considered a sex- and age at admission-adjusted analysis, through a logistic model. The median door-to-balloon time (time between ER arrival and PCI) was computed among nontransfer patients admitted to a ST-e MI receiving facility who did not receive fibrinolysis (n=488). Results. Mean age at admission was 63.8±10.7 years, 74.5% were men. A documented contraindication to therapy was present in 1.4% of the records. Reperfusion treatment (either fibrinolysis or PCI) was administered to 74.7% of eligible patients. Treatment prevalence differed by gender (p-value: 0.04) and age (p-value: <.0001), being lower for women and the elderly (75-79 years old). The time of PCI execution was available on 74% of records. The overall median door-to-balloon time was 123 minutes. Considering primary PCIs (within 6 hours from ER arrival; n=227, 63%), the median time reduced to 74 minutes, and 65% of procedures fulfilled the recommended 90 minutes. This proportion decreased with age (p<0.05) but did not differ by gender. Conclusions. More efforts are needed to raise the prevalence of reperfusion treatment and to shorten the door-to-balloon time for primary PCI, especially among women and the elderly. To improve data completeness, a better standardization of clinical records is desirable.