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PTCA is a minimally invasive procedure that dilates the arteries that supply blood to the cardiac structures (coronary arteries) when they are totally or partially occluded by atherosclerotic plaque. It aims to restore adequate blood flow to a specific region of the heart muscle, preventing the clinical events that characterize myocardial ischemia (angina, myocardial infarction).

Higher volumes have been associated with better outcomes, especially when PTCA is performed in the early phase of an AMI, which requires greater skill and experience than a routine procedure in a stable patient (elective PTCA). The literature has demonstrated an inverse relationship between the timeliness of the procedure in patients with AMI (door-to-balloon time) and short-term mortality.

A recent analysis of systematic reviews in the literature has identified a volume threshold for PTCA of 200/400 cases/year, below which the effectiveness of the care provided could be compromised.

Several randomized controlled trials and meta-analyses have shown improved clinical outcomes (especially a reduction in recurrent ischemic events) in patients with ST-segment elevation myocardial infarction (STEMI) assigned to an early invasive strategy, including PTCA. In patients with STEMI, PTCA is considered the treatment of choice when it can be performed by experienced personnel, in an appropriate cath lab, within 90 minutes of
first contact with the National Health Service.

The choice of management strategy for patients with heart attacks should depend on careful risk stratification and the resources available at the hospital to which the patient arrives. Therefore, the rate of PTCA appears to be significantly higher in patients with heart attacks who arrive directly at hospitals with a cath lab.

A recent meta-analysis has shown that, in patients with STEMI, transfer for mechanical reperfusion is associated with a significant reduction in 30-day mortality.

However, if patients arrive at a hospital without an interventional cath lab, a careful individual assessment must always balance the potential benefits of mechanical reperfusion against the risks of delayed treatment and transportation to the nearest center where this procedure is possible.

Regarding the comparative effectiveness of stent insertion and balloon angioplasty, a recent meta-analysis concluded that this procedure appears to be associated with a reduced risk of recurrent heart attacks and the need for additional
revascularization procedures.

The role of PTCA in the hours immediately following a myocardial infarction can be classified as primary PTCA, PTCA combined with pharmacological reperfusion therapy, and salvage PTCA after failed pharmacological reperfusion.
Primary PTCA is defined as angioplasty without prior or concomitant fibrinolytic therapy; “salvage PTCA” is a PTCA performed on a coronary artery that remains occluded despite fibrinolytic therapy.

Following association tests between outcome trends and new clinical variables introduced in the SDO tracing starting in 2018, it is possible to calculate the outcome from the time of the patient’s admission to the time of PTCA; in this case, a range of
0 to 90 minutes can be considered. Therefore, the following indicators are defined:

1) STEMI: proportion of patients treated with PTCA within 90 minutes of admission to the inpatient facility;
2) STEMI: proportion of patients treated with PTCA within 90 minutes of admission to the inpatient facility compared to the total number of patients treated with PTCA within 12 hours of admission to the inpatient facility.

These indicators, therefore, leverage information on the date and time of admission and PTCA surgery to better characterize the timeliness of intervention associated with this procedure.

The indicators are intended to provide insights into the functioning of the entire hospital care process, beginning with the patient’s admission. Assigning the hospitalization outcome does not imply an assessment of the quality of care provided by that facility, but rather the appropriateness and effectiveness of the care process that begins with the patient’s arrival at that facility.

The value of the indicators may vary between regions and facilities; this phenomenon, in addition to the varying quality of care, may be caused by the heterogeneous distribution, due to case mix, of various risk factors such as age, gender, and patient health conditions.

The Ministry of Health Decree No. 70 of April 2, 2015, on hospital care standards for patients with acute STEMI myocardial infarction (STEMI), establishes a minimum threshold of 60% for the proportion of percutaneous coronary angioplasty performed within 90 minutes of admission.

In addition, the indicator “Scheduled hospitalization for percutaneous coronary angioplasty” was calculated; this indicator is calculated exclusively by area of ​​residence and allows us to assess the variability in the frequency of PTCA procedures across different Italian regions.

Your trusted doctor will address your concerns and guide you towards an informed choice of treatment. Contact him or her for all the information you need for your health needs.