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La Rivista Italiana della Medicina di Laboratorio 2021 Sep 30

DOI: 10.23736/S1825-859X.21.00115-8

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: Italian

Clinical networks for cardiovascular emergency: the role of myocardial markers

Margherita MORANDINI 1 , Piero CAPPELLETTI 2

1 Laboratorio Analisi, ASFO, Pordenone, Italia; 2 SIPMeL, Castelfranco Veneto, Treviso, Italia


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BACKGROUND: The implementation of cardiac emergency networks with pre-hospital electrocardiogram is focused on the timely treatment of STEMI with PCI; now the networks could be progressively used also to optimize the treatment of NSTEMI according to hub & spoke organizations.
METHODS: The organization of Laboratory Medicine of the Vast Area Pordenone (today ASFO), has its hub (LAB) in the Pordenone hospital and its spokes equipped with a laboratory (San Vito and Spilimbergo hospitals) or POCT only (First Intervention Points of Sacile and Maniago). The instrumental equipment of the laboratory cardiac network consists of 1 Dimension Vista 1500 Siemens (Milan, Italy) in the hub and 4 spokes, 1 with Dimension ExL Siemens and 3 POCT Stations (1 First Aid until 2018 and 2 First Intervention Points) with instruments Stratus CS 200 Siemens, supported by two Data Management System (Rapidcomm and POCcelerator) that allow a continuous remote control of the status of the POCT instrumentation, the quality controls and performances, with the possibility of bi-directional interventions.
RESULTS: From the point of view of the general performance of the POCT network and the organizational outcomes, in the period 2012-2015, the most important result was that instrumental / connectivity anomalies (4% per year) was managed remotely by the laboratory. From the point of view of the outcomes of efficiency and appropriateness, measured at the spoke of the Sacile, in the period 2012-15 and then in 2021 after technical and organizational changes, about 9/10% patients were cTn positive, the 75/80% of these were sent to the hub and about 50% directly to the hemodynamics unit (Cath Lab), in the first survey. In the second survey, all patients (15%) transferred to the Cath Lab were NSTEMI.
CONCLUSIONS: The overlapping incidence of suspected Acute Coronary Syndromes (ACS) in the peripheral site (8.7-10.4%) and in the hub center (11%), the limited number of retests for the same patient, the high number of hospitalizations in the hub center of patients selected by the peripheral POCTs, direct hospitalizations in hemodynamics of many patients (in the second survey exclusively NSTEMI), testify to the effectiveness and appropriateness of the ACS
network for NSTEMI.


KEY WORDS: Clinical networks; Myocardial infarction; Troponin

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