Le Urgenze cardiologiche: letalità e trattamento. Analisi di 500 eventi coronarici consecutivi, nell'ambito del "Progetto MONICA Area Brianza"

Recently, a decreasing trend in cardiovascular mortality, starting from 1976-78, has been observed in Italy, particularly in northern regions. In order to explore one possible cause of the phenomenon, a survey of acute coronary care has been performed in a sample area, with about one tenth of the population of Lombardy, the largest and most developed northern Italian region. The survey has been carried out within the framework of the WHO-MONICA project: the treatment of 500 consecutive suspected coronary events in the age group 25-64 years, has been examined according to the international protocol. The following items have been investigated: time between onset of symptoms and medical intervention; characteristics of initial care; cardiac arrest and cardiopulmonary resuscitation in or outside the hospital; intensive care unit admission and length of stay; type of treatment before, during and after the event. Marked improvements have been accomplished in managing cardiac emergency. They have reduced in-hospital coronary mortality by more than 50%. However, several problems were still present at the time of the study, 1986-87: a) only 52% of patients obtained assistance within 4 hours (Tab III); b) cardiac arrest was practically always fatal outside the hospital and in 75% of the cases inside (Tab V); c) essential drugs, e.g. beta-blockers, were not so widespread and substantially absent were angioplasty and coronary bypass surgery (Tab IX). It has been estimated that improving adherence to optimal therapeutic standards might save more than 700 lives a year in Lombardy in the age group 25-65 years.