Incidence, treatment and outcome of acute coronary syndromes: A community-based study in the era of myocardial infarction networks

Institution of a well-functioning network based on pre-hospital diagnosis, close collaboration between hospitals, primary percutaneous coronary intervention (PPCI) centres and emergency medical services (EMS) are strongly recommended in order to achieve early reperfusion and improve clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI) [1], [2], [3], [4], [5]. The presence of inter-hospital networks for STEMI is commonly perceived as a facilitating factor for the implementation of guidelines also in the setting of non ST-segment elevation–acute coronary syndrome (NSTE-ACS), whereas current guidelines encourage early risk stratification and use of an invasive strategy for high-risk patients [6], [7]. In the present study we describe the contemporary incidence, treatment and outcome of the whole spectrum of ACS within an established territorial network for STEMI [4], [5]. Our territory (3702 Km2, 964.074 inhabitants in 2008) was served by 3 hospitals equipped with a high-volume catheterisation laboratory. The remaining hospitals comprised: 3 public hospitals with coronary care unit (CCU); 9 public hospital without CCU and 8 private clinics without CCU