Changes in reperfusion strategy over time for ST segment elevation myocardial infarction in the Greater Paris Area: Results from the e-MUST Registry

Abstract Background ESC guidelines recommend a shorter (90 min) delay for the use of primary percutaneous intervention (pPCI) in patients presenting within the first 2 h of pain onset. Using registry data on STEMI patients in the Greater Paris Area, we assessed changes between 2003 and 2008 in the r...

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Bibliographic Details
Published in:International journal of cardiology 2013-10, Vol.168 (6), p.5149-5155
Main Authors: Karam, Nicole, Lambert, Yves, Tafflet, Muriel, Bataille, Sophie, Benamer, Hakim, Caussin, Christophe, Garot, Philippe, Escolano, Sylvie, Boutot, Françoise, Greffet, Agnès, Letarnec, Jean-Yves, Capitani, Georges-Antoine, Templier, François, Lapandry, Claude, Auger, Arnold, Dupas, François, Dubourdieu, Stéphane, Juliard, Jean-Michel, Spaulding, Christian, Jouven, Xavier
Format: Article
Language:English
Subjects:
Acute coronary syndromes
Acute myocardial infarction
Adult
Aged
Angioplasty, Balloon, Coronary - mortality
Angioplasty, Balloon, Coronary - standards
Biological and medical sciences
Cardiology. Vascular system
Cardiovascular
Catheter based coronary interventions
Coronary heart disease
Diseases of the cardiovascular system
Electrocardiography
Emergency Medical Services - statistics & numerical data
Female
Fibrinolysis
Heart
Hospital Mortality
Humans
Male
Medical sciences
Middle Aged
Myocardial Infarction - diagnosis
Myocardial Infarction - mortality
Myocardial Infarction - therapy
Myocarditis. Cardiomyopathies
Paris - epidemiology
Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
Registries - statistics & numerical data
Risk Factors
Thrombolytic Therapy - mortality
Thrombolytic Therapy - statistics & numerical data
Time-to-Treatment - statistics & numerical data
Treatment Outcome
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Summary:Abstract Background ESC guidelines recommend a shorter (90 min) delay for the use of primary percutaneous intervention (pPCI) in patients presenting within the first 2 h of pain onset. Using registry data on STEMI patients in the Greater Paris Area, we assessed changes between 2003 and 2008 in the rates of pPCI, pre-hospital fibrinolytic therapy (PHF) and time delays in patients presenting within 2 h of STEMI pain onset. Methods The Greater Paris Area was divided in 3 regions: Paris, the small and large rings. Patients were divided in three groups according to their reperfusion strategy: a) PHF, b) timely pPCI (FMC to balloon inflation time < 90 min), and c) late pPCI (FMC to balloon inflation time > 90 min). Results Among the 5592 patients included, 1695 (39%) had PHF, 1266 (29%) had timely pPCI, and 1415 (32%) had late pPCI. Over the 6 years, there was a sharp increase in timely pPCI in all regions, balanced by a decrease in PHF. The rate of late pPCI remained globally stable, with a decrease in Paris, stabilization in the small ring, and an increase in the large ring, where the density of catheterization laboratories was the lowest. By multivariate analysis, using on-time pPCI as a reference group, mortality was higher in the PHF and late pPCI groups. Conclusions In areas with a low density of pPCI centers, efforts should be made to improve the timeliness of pPCI. Otherwise, PHF followed by an immediate transfer to a pPCI capable hospital may be considered.
ISSN:0167-5273
1874-1754
DOI:10.1016/j.ijcard.2013.06.010