Author + information
- Guillermo Aldama Lopez1,
- Melisa Santas2,
- Manuel Lopez Perez3,
- Xacobe Flores1,
- Pablo Pinon1,
- Jorge Salgado1,
- Ramon Calvino1,
- Nicolas Vazquez1 and
- Jose Manuel Vazquez Rodriguez1
The acute myocardial infarction (AMI)-care networks aim to increase reperfusion rates by primary percutaneous coronary intervention (PPCI), reduce myocardial ischemia times and improve survival of patients with this condition. There are very little data on the impact of AMI-care networks in areas where they are developed. In 2005, PROGALIAM (Galician Network of Attention in AMI) was implemented in the northern region of Spain. IPHENAMIC (Impact on the public health of a network in AMI care) (NCT02501070) pretend to know how this program has improved the results in the care of the AMI in the northern region of Galicia with a population of 1.1 million inhabitants.
All patients with a final diagnosis of AMI were included between 2001 and 2011 in the northern region of Galicia. Patients were divided into two groups. Before the implementation of the AMI-care network (2001 to 2005) and post-implementation of the AMI-care network (2006-2011). Baseline characteristics, rates and reperfusion mechanism, ischemia times, and 30-day, one-and-five-year mortality in both groups were compared.
From 2001 to 2011, 5937 AMIs occurred in the northern region of Galicia. 2510 (42%) before implantation of the AMI-care network and 3427 (58%) after the implantation of the AMI-care network. Reperfusion rates increased from 60 to 69% (pre vs post, p <0.05). Reperfusion by fibrinolytic therapy decreased from 69 to 25% (p <0.01) and PPCI rates increased from 31 to 75% (p <0.01). The time of ischemia (time from the first medical contact to reperfusion by PPCI) decreased significantly from a median of 143 min (IQR 92-172) to 130 min (IQR 111-156) (p <0.05). Mortality rates at 30 days, 1 year and 5 years also decreased when periods post vs pre, implantation of a AMI-care network were compared; 13.5% vs 17.3% (p <0.05); 17.2% vs 21.3% (p <0.05) and 27% vs 32% (p <0.05) respectively.
The implementation of an AMI-care network in the northern region of Galicia improved reperfusion rates, increased PPCI rates, reduced ischemic times, and increased survival rates at 30 days, one and five years.
OTHER: Public Health Issues