State-of-the-art STEMI care: the case for an in-hospital 24/7 ready PCI team integrated in a modern EMS network

From Top Italian Scientists Journal
Published
March 9, 2026
Title
State-of-the-art STEMI care: the case for an in-hospital 24/7 ready PCI team integrated in a modern EMS network
Authors
Francesco Versaci, Giuseppe Biondi-Zoccai, Emanuele Barbato, Deepak L. Bhatt
DOI
10.62684/YKGZ4180
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Francesco Versaci(1), Giuseppe Biondi-Zoccai(2,3), Emanuele Barbato(4), Deepak L. Bhatt(5)

(1)Department of Cardiology, Santa Maria Goretti Hospital, Latina, Italy;

(2)Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy;

(3)Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy;

(4)Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy;

(5)Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, New York, USA;

Correspondence to: Prof. Giuseppe Biondi-Zoccai, Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 74, 04100 Latina, Italy. Email: giuseppe.biondizoccai@uniroma1.it

Abstract

Contemporary care of patients with ST-elevation myocardial infarction (STEMI) with primary percutaneous coronary intervention (PCI) is still dominated by “24/7 PCI-capable” hospital model, whereas a novel approach encompassing true “PCI now” capabilities could provide meaningful clinical benefits. Indeed, prehospital electrocardiogram (ECG) acquisition, early emergency medical service activation of the interventional team, direct transfer to the catheterization laboratory when appropriate, and continuous in-house staff coverage may reduce treatment delays, especially during off-hours, and may improve clinical outcomes. In this perspective, first-medical-contact-to-PCI and total ischemic time appear more meaningful quality indicators than door-to-balloon time alone, as also testified by regional data from Lazio and the experience from Santa Maria Goretti Hospital in Latina which show how delays frequently arise when patients first present to non-PCI hospitals, whereas organized direct-transfer pathways may streamline care. Development of centralized, sectorized STEMI networks, together with transparent auditing of performance and safeguards against false-positive activation, including ECG transmission, teleconsultation, standardized criteria, and validated artificial intelligence tools, may allow a safer and more effective management of STEMI. We hereby thus formally propose the universal adoption of such PCI now approach for STEMI care.

Declarations

Acknowledgements

This manuscript was drafted and illustrated with the assistance of artificial intelligence tools, such as ChatGPT 5.2 (OpenAI, San Francisco, CA, USA), in keeping with established best practices (Biondi-Zoccai G, editor. ChatGPT for Medical Research. Torino: Edizioni Minerva Medica; 2024). The final content, including all conclusions and opinions, has been thoroughly revised, edited, and approved by the authors. The authors take full responsibility for the integrity and accuracy of the work and retain full credit for all intellectual contributions. Compliance with ethical standards and guidelines for the use of artificial intelligence in research has been ensured.

Conflict of Interest

The authors declare there is no conflict of interest.

Funding

None

Author contributions

This manuscript was conceived, co-drafted and supervised by Dr. Versaci. Dr. Biondi-Zoccai co-drafted the manuscript, generated the figure, and revised its final version. Drs. Barbato and Bhatt provided critical comments and revisions to the draft, and key input on evidence and organizational aspects. All authors read and approved the final version of the manuscript”.

Disclosure

Dr. Biondi-Zoccai has consulted, lectured and/or served as advisory board member and/or expert witness for Abiomed, Advanced Nanotherapies, Amarin, AstraZeneca, Balmed, Cardionovum, Cepton, Crannmedical, Endocore Lab, Eukon, Guidotti, Innova HTS, Innovheart, Menarini, Microport, Opsens Medical, Otsuka Medical Devices Europe, Recor, Servier, Synthesa, Terumo, and Translumina, outside the present work. Dr. Bhatt discloses the following relationships - Advisory Board: Angiowave, Antlia Bioscience, Bayer, Boehringer Ingelheim, CellProthera, Cereno Scientific, E-Star Biotech, High Enroll, Janssen, Level Ex, McKinsey, Medscape Cardiology, Merck, NirvaMed, Novo Nordisk, Repair Biotechnologies, Stasys, SandboxAQ (stock options), Tourmaline Bio, Viatris; Board of Directors: American Heart Association New York City, Angiowave (stock options), Bristol Myers Squibb (stock), DRS.LINQ (stock options), High Enroll (stock); Consultant: Alnylam, Altimmune, Broadview Ventures, Corcept Therapeutics, Corsera, GlaxoSmithKline, Hims, SERB, SFJ, Summa Therapeutics, Worldwide Clinical Trials; Data Monitoring Committees: Acesion Pharma, Assistance Publique-Hôpitaux de Paris, Baim Institute for Clinical Research, Boston Scientific (Chair, PEITHO trial), Cleveland Clinic, Contego Medical (Chair, PERFORMANCE 2), Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ABILITY-DM trial, funded by Concept Medical; for ALLAY-HF, funded by Alleviant Medical), Novartis, Population Health Research Institute; Rutgers University (for the NIH-funded MINT Trial); Honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org; Chair, ACC Accreditation Oversight Committee), Arnold and Porter law firm (work related to Sanofi/Bristol-Myers Squibb clopidogrel litigation), Baim Institute for Clinical Research (AEGIS-II executive committee funded by CSL Behring), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Canadian Medical and Surgical Knowledge Translation Research Group (clinical trial steering committees), CSL Behring (AHA lecture), Duke Clinical Research Institute, Engage Health Media, HMP Global (Editor in Chief, Journal of Invasive Cardiology), Medtelligence/ReachMD (CME steering committees), MJH Life Sciences, Oakstone CME (Course Director, Comprehensive Review of Interventional Cardiology), Philips (Becker's Webinar on AI), Population Health Research Institute, WebMD (CME steering committees), Wiley (steering committee); Other: Clinical Cardiology (Deputy Editor, unpaid); Progress in Cardiovascular Diseases (Deputy Editor, unpaid); Added Health (Editorial Board; stock options); Patent: Sotagliflozin (named on a patent for sotagliflozin assigned to Brigham and Women's Hospital who assigned to Lexicon; neither I nor Brigham and Women's Hospital receive any income from this patent); Research Funding: Abbott, Acesion Pharma, Afimmune, Alnylam, Amarin, Amgen, AstraZeneca, Atricure, Bayer, Boehringer Ingelheim, Boston Scientific, CellProthera, Cereno Scientific, Chiesi, Cleerly, CSL Behring, Faraday Pharmaceuticals, Fractyl, Idorsia, Janssen, Javelin, Lexicon, Lilly, Medtronic, Merck, MiRUS, Moderna, Novartis, Novo Nordisk, Pfizer, PhaseBio, Regeneron, Reid Hoffman Foundation, Roche, Sanofi, Stasys, 89Bio; Royalties: Elsevier (Editor, Braunwald’s Heart Disease); Site Co-Investigator: Cleerly. Dr. Barbato declares consultancy fees from Abbott, BSCI, Insight Lifetech, and Medtronic. Dr. Versaci reports no conflicts of interest.

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