Skip to main content
SpringerLink
Log in

Management of acute myocardial infarction in the real world: a summary report from The Ami-Florence Italian Registry

  • IM - Original
  • Published:
Internal and Emergency Medicine Aims and scope Submit manuscript

Abstract

The Florence Acute Myocardial Infarction registry was a population-based, prospective study aimed at identifying the determinants of coronary reperfusion therapy [CRT, by primary coronary intervention (PCI) in more than 95% of cases] utilization and of prognosis in patients with ST-segment elevation myocardial infarction (STEMI). The registry involved one teaching hospital with, and five district hospitals without PCI facilities. Overall, as many as 45.6% of 930 cases of STEMI did not receive any form of CRT. In multivariable analysis, the direct admission to the teaching hospital was the strongest positive predictor, whereas the time delay, older age, and chronic comorbid conditions were negative predictors of CRT utilization. Compared to conservative therapy, CRT was associated with a remarkably reduced 12-month mortality, after adjusting for age, chronic comorbidities and Killip class, which also were significantly associated with long-term prognosis. The higher crude mortality observed in women was accounted for by older age and other age-related factors. The improvement in prognosis with CRT was larger in older patients and/or in those with a greater burden of chronic comorbidity, who less frequently received CRT. These results suggest the need for interdisciplinary reassessing the adherence to therapeutic guidelines and the criteria adopted in the real clinical world to select patients for CRT during STEMI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Buiatti E, Barchielli A, Marchionni N et al (2003) 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). Eur Heart J 24:1195–1203

    Article  PubMed  Google Scholar 

  2. Ryan TJ, Antman EM, Brooks NH et al (1999) Update: ACC/AHA Guidelines for the management of patients with acute myocardial infarction: executive summary and recommendations: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). Circulation 100:1016–1030

    PubMed  CAS  Google Scholar 

  3. Keeley EC, Boura JA, Grines CL (2003) Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet 361:13–20

    Article  PubMed  Google Scholar 

  4. Balzi D, Barchielli A, Buiatti E et al (2006) Effect of comorbidity on coronary reperfusion strategy and long-term mortality after acute myocardial infarction. Am Heart J 151:1094–1100

    Article  PubMed  Google Scholar 

  5. Antman EM, Anbe DT, Armstrong PW et al (2004) ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction-executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction). J Am Coll Cardiol 44:671–719

    Article  PubMed  Google Scholar 

  6. Carruthers KF, Dabbous OH, Flather MD, Starkey I, Jacob A, Macleod D, Fox KA (2005) GRACE investigators. Contemporary management of acute coronary syndromes: does the practice match the evidence? The global registry of acute coronary events (GRACE). Heart 91(3):290–298

    Article  PubMed  CAS  Google Scholar 

  7. Barchielli A, Buiatti E, Balzi D et al (2004) Age-related changes in treatment strategies for acute myocardial infarction: a population-based study. J Am Geriatr Soc 52:1355–1360

    Article  PubMed  Google Scholar 

  8. Carrabba N, Santoro GM, Balzi D et al (2004) In-hospital management and outcome in women with acute myocardial infarction (data from the AMI-Florence Registry). Am J Cardiol 94:1118–1123

    Article  PubMed  Google Scholar 

  9. GISSI-2 (1990) A factorial randomised trial of alteplase versus streptokinase and heparin versus no heparin among 12,490 patients with acute myocardial infarction. Gruppo Italiano per lo Studio della Sopravvivenza nell’Infarto Miocardico. Lancet 336:65–71

    Google Scholar 

  10. Fibrinolytic Therapy Trialists’ (FTT) Collaborative Group (1994) Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1,000 patients. Lancet 343:311–322

    Google Scholar 

  11. Wood E, Sallar AM, Schechter MT, Hogg RS (1999) Social inequalities in male mortality amenable to medical intervention in British Columbia. Soc Sci Med 48:1751–1758

    Article  PubMed  CAS  Google Scholar 

  12. Di Chiara A, Chiarella F, Savonitto S et al (2003) Epidemiology of acute myocardial infarction in the Italian CCU network—The BLITZ Study. Eur Heart J 24:1616–1629

    Article  PubMed  Google Scholar 

  13. Stenestrand U, Lindback J, Wallentin L (2006) Long-term outcome of primary percutaneous coronary intervention vs prehospital and in-hospital thrombolysis for patients with ST-elevation myocardial infarction. JAMA 296:1749–1756

    Article  PubMed  CAS  Google Scholar 

  14. Keeley EC, Grines CL (2004) Primary coronary intervention for acute myocardial infarction. JAMA 291:736–739

    Article  PubMed  CAS  Google Scholar 

  15. Mehta RH, Granger CB, Alexander KP, Bossone E, White HD, Sketch MH Jr (2005) Reperfusion strategies for acute myocardial infarction in the elderly: benefits and risks. J Am Coll Cardiol 45:471–478

    Article  PubMed  Google Scholar 

  16. Barron HV, Bowlby LJ, Breen T et al (1998) Use of reperfusion therapy for acute myocardial infarction in the United States: data from the National Registry of Myocardial Infarction 2. Circulation 97:1150–1156

    PubMed  CAS  Google Scholar 

  17. Eagle KA, Goodman SG, Avezum A et al (2002) Practice variation and missed opportunities for reperfusion in ST-segment-elevation myocardial infarction: findings from the Global Registry of Acute Coronary Events (GRACE). Lancet 359:373–377

    Article  PubMed  Google Scholar 

  18. Parmley WW (1997) Do we practice geriatric cardiology? J Am Coll Cardiol 29:217–218

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Epidemiology Unit, Azienda Sanitaria Firenze, Viale Michelangelo 41, 50125, Florence, Italy

    Daniela Balzi & Alessandro Barchielli

  2. Division of Cardiology 1, Ospedale Nuovo S. Giovanni di Dio, Costa dei Magnoli 28, 50125, Florence, Italy

    Giovanni Maria Santoro

  3. Division of Cardiology, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50139, Florence, Italy

    Nazario Carrabba

  4. Epidemiology Unit, Agenzia Regionale di Sanità della Toscana, Viale Milton 7, 50134, Florence, Italy

    Eva Buiatti

  5. Division of Internal Medicine and General Cardiology, Azienda Ospedaliero-Universitaria Careggi, Viale Morgagni 85, 50139, Florence, Italy

    Cristina Giglioli, Serafina Valente & Gian Franco Gensini

  6. Division of Geriatric Cardiology, Department of Cardiology and Vascular Medicine, Azienda Ospedaliero-Universitaria Careggi, Via delle Oblate 4, 50141, Florence, Italy

    Giorgio Baldereschi, Laura Del Bianco, Matteo Monami & Niccolò Marchionni

Authors
  1. Daniela Balzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alessandro Barchielli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giovanni Maria Santoro
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Nazario Carrabba
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eva Buiatti
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Cristina Giglioli
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Serafina Valente
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Giorgio Baldereschi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Laura Del Bianco
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Matteo Monami
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Gian Franco Gensini
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Niccolò Marchionni
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

for the AMI-Florence Working Group

Corresponding author

Correspondence to Niccolò Marchionni.

Additional information

AMI-Florence Working Group

Azienda Ospedaliero-Universitaria Careggi: G. M. Santoro, N. Carrabba (Cardiology 1), G. Santoro, G. Corti (Invasive Cardiology), M. Margheri (Cardiology 2), S. Valente (Internal Medicine and General Cardiology), N. Marchionni, M. Monami (Geriatric Cardiology), F. Ferrante (Internal Medicine 1), V. Verdiani (Internal Medicine 2), I. Olivotto (Internal Medicine 3). Azienda Sanitaria di Firenze: A. Barchielli, D. Balzi, V. Lazzeri, P. Naldoni, C. Melani, M. Maci (Epidemiology Unit); R. Vergassola, L. Fratoni (Emergency Service 118). Santa Maria Annunziata Hospital: A. Fantini (Cardiology), M. Torri (Internal Medicine 1), G. Regoli, C. Mugnaini (Internal Medicine 2). Santa Maria Nuova Hospital: M. C. Landini (Cardiology), M. Granelli (Internal Medicine 1). Nuovo San Giovanni di Dio Hospital: M. Filice (Cardiology), P. Fabiani (Internal Medicine 1). Mugello Hospital: F. Miglietta (Intensiva Care Unit), L. Scarti, I. Berni (Internal Medicine). Figline Hospital: G. Fabrizi de Biani, F. A. Tarmun (Internal Medicine). Agenzia Regionale di Sanita` della Toscana: E. Buiatti, S. Arniani, S. Bartolacci (Epidemiology Unit).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Balzi, D., Barchielli, A., Santoro, G.M. et al. Management of acute myocardial infarction in the real world: a summary report from The Ami-Florence Italian Registry. Intern Emerg Med 3, 109–115 (2008). https://doi.org/10.1007/s11739-008-0090-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11739-008-0090-x

Keywords

Search

Navigation