Aim of this paper is to investigate into the differences in the first treatment of Acute Myocardial Infarction (AMI) among Italian regional health care systems, by focusing on the regional distribution of in-hospital deaths. Starting from the theoretical care pathway (from the onset of the illness to hospitalization and recovery or possible death), the in-hospital deaths in each region are decomposed into the contributions of the attack rate, hospitalization and in-hospital fatality. The discrepancies in regional behaviour are investigated, in the aim to assess whether they can be attributed to different performances among Italian regions. The study is based on two data sources: hospital discharges, based on Diagnosis Related Groups (DRG) and provided by the Ministry of Health; death and population data by regions of residence, provided by the National Institute of Statistics