[How to match resources with appropriateness: lessons from the registries of the Italian Association of Hospital Cardiologists].

International guidelines issued in recent years by the European Society of Cardiology and the American College of Cardiology/American Heart Association were aimed at presenting all the relevant evidence in the management of acute coronary syndromes and at helping physicians in routine clinical decision-making in order to weigh the benefits and risks of diagnostic or therapeutic procedures. A recent debate has been held in the scientific community about the correct interpretation of guidelines and the methods concerning the process of their implementation. Some of their limitations have been discussed as well.

[The network for the management of acute coronary syndromes in Milan: results of a four-year experience and perspectives of the prehospital and interhospital cardiological network].

In patients with acute ST-elevation myocardial infarction (STEMI), in order to shorten the time to definitive treatment, it is essential to coordinate the intervention between the local healthcare system and the hospitals. In 1999, a Working Group for Prehospital Emergency in Cardiology was established in Milan, and a network for 12-lead ECG transmission between advances life support (ALS) ambulances, the headquarter of 118 Rescue Service and the Coronary Care Units (CCU) or Divisions of Cardiology was developed: between February 1, 2001 and May 1, 2005, 6821 patients with suspected heart attack were rescued and their ECG recorded and transmitted (177 patients/month, 20% of them with an ST-segment shift, 11% ST-segment elevation, 9% non-ST-segment elevation, 24% with normal ECG). The rate of false positive automatic diagnosis of acute myocardial infarction was 0.

[The early management of ST-elevation acute myocardial infarction in the Lombardy Region (GestIMA)].

Background: Recent international and national surveys on the management of ST-elevation myocardial infarction have described a number of crucial issues regarding the prehospital phase, the criteria to address patients to primary angioplasty, the organization of interhospital transfers. GestIMA is a perspective survey organized by the Lombardy Sections of the Italian Cardiology Societies (ANMCO and SIC) aimed to investigate the management of the acute phase of myocardial infarction in the Lombardy Region.

Methods: Between October 15 and November 14, 2003, consecutive patients hospitalized for ST-elevation myocardial infarction in the coronary care units of 60 hospitals in Lombardy were enrolled into the study.

[Acute coronary syndromes without persistent ST-segment elevation: is risk stratification correctly applied?].

Risk stratification of patients with acute coronary syndromes is of paramount importance in achieving maximal benefit from current therapeutic modalities and for correct resource allocation. Since risk prediction based on the integration of key prognostic variables is relatively inaccurate, the clinical guidelines of the European Society of Cardiology (which have been endorsed by the Italian Federation of Cardiology) suggest an univariate approach favoring the sensitivity of the detection of high-risk patients compromising specificity. Such an approach is likely to identify a large population of high-risk patients possibly causing a mismatch between the number of patients in need of invasive evaluation and treatment, and the availability of interventional resources.

Clinical significance of a single measurement of troponin-I and C-reactive protein at admission in 1773 consecutive patients with acute coronary syndromes.

Background: The clinical significance of biochemical markers of myocardial damage or inflammation has not been prospectively established in populations representing the whole spectrum of acute coronary syndromes. We investigated whether the elevation of these biomarkers at admission has a prognostic value that is independent and incremental to baseline clinical variables and quantitative electrocardiographic ischemia.

Methods: We measured blood levels of cardiac troponin I (cTnI) and C-reactive protein (CRP) in 1773 consecutive patients admitted to 31 Italian coronary care units within 12 hours from an episode of acute coronary syndrome.