Five-year evolution of reperfusion strategies and early mortality in patients with ST-segment elevation myocardial infarction in France

Eur Heart J Acute Cardiovasc Care. 2017 Oct;6(7):573-582. doi: 10.1177/2048872615623065. Epub 2015 Dec 17.

Abstract

Aim: To assess 5-year evolutions in reperfusion strategies and early mortality in patients with ST-segment elevation myocardial infarction.

Methods and results: Using data from the French RESCUe network, we studied patients with ST-segment elevation myocardial infarction treated in mobile intensive care units between 2009 and 2013. Among 2418 patients (median age 62 years; 78.5% male), 2119 (87.6%) underwent primary percutaneous coronary intervention and 299 (12.4%) pre-hospital thrombolysis (94.0% of whom went on to undergo percutaneous coronary intervention). Use of primary percutaneous coronary intervention increased from 78.4% in 2009 to 95.9% in 2013 ( Ptrend<0.001). Median delays included: first medical contact to percutaneous coronary intervention centre 48 minutes; first medical contact to balloon inflation 94 minutes; and percutaneous coronary intervention centre to balloon inflation 43 minutes. Times from symptom onset to first medical contact and first medical contact to thrombolysis remained stable during 2009-2013, but times from symptom onset to first balloon inflation, and first medical contact to percutaneous coronary intervention centre to first balloon inflation decreased ( P<0.001). Among patients with known timings, 2146 (89.2%) had a first medical contact to percutaneous coronary intervention centre delay ⩽90 minutes, while 260 (10.8%) had a longer delay, with no significant variation over time. Primary percutaneous coronary intervention use increased over time in both delay groups, but was consistently higher in the ⩽90 versus >90 minutes delay group (83.0% in 2009 to 97.7% in 2013; Ptrend<0.001 versus 34.1% in 2009 to 79.2% in 2013; Ptrend<0.001). In-hospital (4-6%) and 30-day (6-8%) mortalities remained stable from 2009 to 2013.

Conclusion: In the RESCUe network, the use of primary percutaneous coronary intervention increased from 2009 to 2013, in line with guidelines, but there was no evolution in early mortality.

Keywords: ST-segment elevation myocardial infarction; mobile intensive care units; mortality; primary percutaneous coronary intervention; thrombolysis.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Electrocardiography
  • Emergency Medical Services / statistics & numerical data*
  • Female
  • Follow-Up Studies
  • France / epidemiology
  • Hospital Mortality / trends
  • Humans
  • Male
  • Middle Aged
  • Myocardial Reperfusion / standards*
  • Practice Guidelines as Topic*
  • Retrospective Studies
  • Risk Assessment / methods*
  • Risk Factors
  • ST Elevation Myocardial Infarction / diagnosis
  • ST Elevation Myocardial Infarction / mortality
  • ST Elevation Myocardial Infarction / therapy*
  • Survival Rate / trends
  • Time Factors