P234 IT IS TIME THAT ITALIAN AMI NETWORKS ARE BASED ON DIAGNOSTIC–THERAPEUTIC PATHWAYS INCLUDING BOTH TYPES OF ACS (STEMI AND NSTEMI)

Abstract

Abstract Background Nowadays AMI management represents one of the most challenging clinical scenarios. On 8 july 2022 ANMCO held a special event about the last 20 years of AMI networks in Italy. During this event it was highlighted how these networks – supported by ANMCO – led to mortality reduction in the last 20 years (till –57%). By the way, the networks are usually based on diagnostic–therapeutic (D–T) pathways that not include NSTEMI–ACS. At contrary, the prevalence of NSTEMI–ACS is increasing and it significantly contributes to whole mortality due to coronary heart disease in the world. Materials and Methods The Functional Cardiology Department of Marche Region (Italy) covers the territory of three provinces. This department provided a new diagnostic–therapeutic pathway for AMI–network on July 2022. Globally, the department provides heart diseases management to 500.000 subjects living in that area. Working group who proposed the new D–T pathway included: 1) all Cardiology Units Directors; 2) all Emergency System Directors; 3) all Emergency Rooms Directors. The diagnostic–therapeutic pathway was based on 1) latest ESC guidelines and whole medical licterature on the topic; 2) geographic area features; 3) logistic local criticisms; 4) multiple sharing meetings results. Results The D–T pathway was divided in two chapters: 1) STEMI–ACS; 2) NSTEMI–ACS. STEMI–ACS chapter included 7 steps: 1) Symptoms onset and Emergency System Alert; 2) out of hospital intervention; 3) emergency room (ER) intervention; 4) primary PCI; 5) in–hospital complications; 6) whole in–hospital management and back transfer to the spoke; 7) cardiac rehabilitation and secondary prevention programs. The novelties were represented by: 1) ECG trasmission to the ICUs; 2) detailed establishment of which HUB every town/city of the area is assigned to; 3) inclusion of cardiac rehabilitation and secondary prevention programs in the pathway; 4) inclusion of NSTEMI–ACS with the two revascularization arms cited by the ESC guidelines. Conclusions The reported D–T pathway appears very innovative in order to including both two types of ACSs (STEMI and NSTEMI). Considering the latest guidelines, it could be appropriate that new D–T pathways, promoted by AMI networks in Italy, include a specific chapter dedicated to NSTEMI–ACS, given that also this type of ACS may require a time–dependent revascularization therapy and the correct approach may affect mortality and the whole prognosis.