Gestione organizzativa e funzionale dell’infarto miocardico senza sopraslivellamento del tratto ST in Italia: i risultati della survey nazionale “Caduti nella Rete”

BACKGROUND: Differently from the structured network for ST-elevation myocardial infarction (STEMI), which is characterized by standardized transfer protocols and well-defined pathways and is well-established in most Italian regions and provinces, the management of non-STEMI (NSTEMI) still presents organizational gaps, as it lacks a dedicated network in nearly all areas. METHODS: An ANMCO 15-item survey was conducted among hospital cardiologists to assess logistics, decision-making, and timing of invasive coronary angiography (ICA). A total of 539 questionnaires were collected from Hub (65.1%) and Spoke (34.9%) centers. RESULTS: ECG tele-transmission is available in 90.9% of settings; transfers mainly occur via advanced life-support ambulances. ICA timing is primarily driven by hemodynamic instability and ST-T changes, while the GRACE score is not systematically used. Overall, 80.3% of patients are transferred within 24-48 h. Significant regional differences were observed in 24/7 cath lab availability, presence of cardiac surgery, transport models, and early return to Spoke practices. CONCLUSIONS: The survey highlights good technological resources but marked heterogeneity in NSTEMI management. Findings support the need for shared protocols, interoperable telecardiology platforms, and uniform criteria for risk stratification and patient transfers.