Background: We report the preliminary data from a regional registry on ST-elevation myocardial infarction (STEMI) patients treated with primary angioplasty in Apulia, Italy; the region is covered by a single public health-care service, a single public emergency medical service (EMS), and a single tele-medicine service provider. Methods: Two hundred and ninety-seven consecutive patients with STEMI transferred by regional free public EMS 1-1-8 for primary-PCI were enrolled in the study; 123 underwent pre-hospital electrocardiograms (ECGs) triage by tele-cardiology support and directly referred for primary-PCI, those remaining were just transferred by 1-1-8 ambulances for primary percutaneous coronary intervention (PCI) (diagnosis not based on tele-medicine ECG; already hospitalised patients, emergency-room without tele-medicine support). Time from first ECG diagnostic for STEMI to balloon was recorded; a time-to-balloon <1 h was considered as optimal and patients as timely treated. Results: Mean time-to-balloon with pre-hospital triage and tele-cardiology ECG was significantly shorter (0:41±0:17 vs 1:34±1:11 h, p<0.001, –0:53 h, –56%) and rates of patients timely treated higher (85% vs 35%, p<0.001, +141%), both in patients from the ‘inner’ zone closer to PCI catheterisation laboratories (0:34±0:13 vs 0:54±0:30 h, p<0.001; 96% vs 77%, p<0.01, +30%) and in the ‘outer’ zone (0:52±0:17 vs 1:41±1:14 h, p<0.001; 69% vs 29%, p<0.001, +138%). Results remained significant even after multivariable analysis (odds ratio for time-to-balloon 0.71, 95% confidence interval (CI) 0.63–0.80, p<0.001; 1.39, 95% CI 1.25–1.55, p<0.001, for timely primary-PCI). Conclusions: Pre-hospital triage with tele-cardiology ECG in an EMS registry from an area with more than one and a half million inhabitants was associated with shorter time-to-balloon and higher rates of timely treated patients, even in ‘rural’ areas.

Purpose: To evaluate waiting lists during the coronary artery bypass graft (CABG) diagnostictherapeutic pathway of patients, in order to detect the actual waiting time between diagnostic evaluation and surgery, and to explore if coronary angiography provides an option as a starting point of waiting lists for CABG patients. Methods: We analyzed 496 hospital discharge cards (year 2009) from main cardiac surgery units in Apulia, Italy. Exclusion criteria were emergency patients coming from regions other than Apulia, and CABG associated with cardiac valve surgery. Results: A total of 97.6% patients underwent CABG within 0-30 days of their reservation date, and 81.7% passed from the first diagnostic step to coronary angiography within 0-30 days. The mean time delay in the diagnostic (ie, the time elapsing from the date of first test performed to detect coronary heart disease and that of coronary angiography) and therapeutic (ie, the time elapsing from the date of waiting-list admission and that of cardiac surgery unit admission) phases was 17.3 ± 31.306 and 5.09 ± 9.375 days respectively; 27% and 19.8% underwent CABG within the same day or at least the day after reservation day, whilst 47.2% completed the diagnostic phase on the same day. Conclusion: The waiting lists for CABG surgery diagnostic-therapeutic phase in Apulia are short.