Regional differences and Italian charter to expand the primary angioplasty service

Italy was one of the first countries in Europe to perform primary percutaneous coronary intervention (p-PCI) and some regions are still a model for the ST-elevation myocardial infarction (STEMI) network organisation. However, in Italy, as in other European countries, some regional disparities have emerged which are related to geographical, economic, organisational and structural issues. Although some regions have excellent STEMI networks, others still have to develop a model which will allow each STEMI patient to receive the best reperfusion treatment. Seven areas where patient clinical needs are not met were identified as primary "Stent for Life" targets in Italy: five main regions in the south of Italy, namely Campania, Sicilia, Puglia, Basilicata and Calabria, and two major areas in the north, the districts of Piemonte and Veneto. In this review we describe socio-political issues and orographic barriers to implementation of STEMI guidelines that have been identified and some hints on what we have done in each target region in order to expand the p-PCI service.