Networks for Life

The very early phase of STEMI is the most critical one, because patients can die before the medical system can reach them and because the best treatment for STEMI is reperfusion therapy given as soon as possible, either by pharmacological fibrinolysis or primary PCI (coronary angiography and angioplasty, with stent placement in the coronaries). As a matter of fact, “time is muscle” for STEMI patients and the later the culprit occluded coronary artery is opened; the worse the outcome for patients.

Patients’ delay in seeking care is the most difficult to shorten, even with public information and educational campaigns; a European-based unique emergency telephone number could be of great help in reducing delays. Both pre-hospital and in-hospital delays are shortened by a direct communication between pre-hospital caregivers and ICCU (Intensive Cardiac Care Unit) and catheterization laboratory, with a clear-cut reduction in mortality.

Ambulance service has a key role in networking: it provides the earliest access to the medical emergency system (EMS), allows teleconsultation with a referral centre (with ECG transmission), can provide pre-hospital therapy (fibrinolysis) and offer a fast and safe transportation to the most appropriate (not always the nearest) cardiological center (to perform primary PCI).


Primary PCI is the most effective reperfusion therapy, when administered early by an experienced interventional team. If primary PCI is not feasible within 2 hours from the first medical contact, fibrinolytic therapy has to be given (possibly in the pre-hospital phase), unless contraindicated. Fibrinolysis, anyway, is not the final treatment, as rescue or systematic PCI are frequently indicated.

In conclusion, networks among cardiological centres linked by an efficient EMS are the cornerstone of modern STEMI treatment and have a pivotal role in assuring an equitable access to high quality STEMI care. Mean features of networks are: clear definition of geographical areas; tiered protocol according to risk stratification; safe and fast transportation; strict organization to reduce delays; pre-hospital transfer protocols that bypass non-PCI capable hospitals; close cooperation among centres; pre-hospital treatment (particularly fibrinolytic) protocols.

“Take-home” message: “A well designed regional system of care is the main goal of the modern organization of STEMI treatment, based on pre-hospital diagnosis, triage and treatment, with a fast and safe transportation to the most appropriate hospital facility, to ensure an equitable access to high quality care”.