Modello fast-track per la gestione dei pazienti con sindrome coronarica acuta senza sopraslivellamento del tratto ST. Esperienza Hub-Spoke in Umbria

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BACKGROUND: Optimization of the management of patients with non-ST-elevation acute coronary syndrome (NSTE-ACS) in terms of relationships between centers with and without cardiac catheterization facilities is still open to debate. We investigated the practical application of a fast-track model for the management of patients with NSTE-ACS in the Perugia Hub Hospital Area (Italy). METHODS: The protocol involved invasive coronary angiography (ICA) at the Hub center after the patient had been transported safely by ambulance with a doctor and nurses from the Spoke center to the Hub center's catheterization laboratory, and then transferred back to the original facility at the end of the procedure in a similar manner. We defined an efficacy outcome (percentage of patients admitted to Spoke centers who, as described above, underwent ICA within 72 h after admission) and a safety outcome (major adverse events during the procedure, transport, and in the first 24 h after return to the Spoke center). RESULTS: Overall, 1048 patients with NSTE-ACS between January 2020 and June 2025 were included in the study. Of these, 91% underwent ICA within the 72 h timeframe. A total of 644 patients (61.5%) underwent immediate percutaneous coronary intervention (PCI) at the Hub center, and 91 of these were retained at the Hub center due to the complexity of their clinical condition. Four serious adverse events occurred: one cardiovascular death due to cardiogenic shock, one severe femoral hematoma, and two acute stent thromboses occurring 5 and 6 h after the procedure, respectively, which required emergency referral for primary PCI. CONCLUSIONS: The above fast-track protocol proved feasible and associated with both logistical benefits and high patient safety. Rapid access to coronary revascularization and immediate return transport to the center of origin were guaranteed in this patient population.

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