[Therapy of acute myocardial infarction in primary care and emergency medicine: experience acquired in the National Interventional Cardiology Program].

Since the highly efficient treatment of acute myocardial infarction (AMI) depends on the time elapsed from the occurrence of symptoms, the speed and accurate diagnosis as well as risk stratification highly influence the outcome of treatment and life prognosis. The basis of prehospital diagnosis of AMI is history, clinical examination and pre-hospital 12-lead electrocardiography performed within 10 minutes from establishment of the first contact with a health institution. Care of patients suffering from AMI by emergency service or primary care physicians needs to include monitoring, use of emergency medicines and transportation to the institution that can put the most efficient treatment strategy in place depending on the length of difficulties, type and localization of AMI, and degree of risk in each individual patient. In Croatia, the integrated diagnostic-therapy-organizational systems of care for "real-world" patients with AMI within the National Interventional Cardiology Program have been applied since the mid-2005. This treatment strategy including prehospital notification and activation of cardiac catheterization laboratory uses primary percutaneous coronary intervention, aimed at more effective life saving and disability reduction than in case of traditional pharmacology-based strategy. Apart from coordination between out-of-hospital healthcare and secondary and tertiary institutions, an adequate support and financial resources provided by local community are required. The purpose of this paper is to present implementation of a modern strategy of prehospital management of all patients with AMI, which, in the conditions of integrated medical care, requires appropriate choice of treatment according to the risk.