Reperfusion des infarctus aigus avec sus-décalage du segment ST dans le RENAU/RESURCOR : des recommandations à la pratique [Reperfusion in ST elevation myocardial infarction. From the guidelines to practice]

Détails

ID Serval
serval:BIB_7ADF55180E9C
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Reperfusion des infarctus aigus avec sus-décalage du segment ST dans le RENAU/RESURCOR : des recommandations à la pratique [Reperfusion in ST elevation myocardial infarction. From the guidelines to practice]
Périodique
Annales de cardiologie et d'angeiologie
Auteur⸱e⸱s
Duraffourg A., Yayehd K., Fourny M., Turk J., Massoutier M., Ageron F.X., Debaty G., Ricard C., Vanzetto G., Belle L., Labarere J.
ISSN
1768-3181 (Electronic)
ISSN-L
0003-3928
Statut éditorial
Publié
Date de publication
11/2014
Peer-reviewed
Oui
Volume
63
Numéro
5
Pages
312-320
Langue
français
Notes
Publication types: Comparative Study ; English Abstract ; Journal Article ; Observational Study
Publication Status: ppublish
Résumé
International guidelines have recommendations for selecting the type of reperfusion (fibrinolysis or angioplasty) in the setting of ST-segment elevation myocardial infarction (STEMI), and suggest that emergency-care networks adapt these recommendations according to the local environment.
To assess the proportions of STEMI patients treated with fibrinolysis or angioplasty in accordance with regional guidelines.
Observational study based on a permanent registry of patients with STEMI of <12h duration in an emergency network in the French North Alps (Isère, Savoie, Haute-Savoie) from January 2009 to December 2012.
The registry included 2620 patients. Reperfusion was given in 2425/2620 (93%) of patients. Reperfusion type was in accordance with recommendations in 1567/2620 (60%) patients. Guideline-recommended fibrinolysis and angioplasty were performed in 47% (656/1385) and 79% (911/1149) respectively, of patients. In multivariable analysis, variables independently associated with guideline-recommended reperfusion were: an age < 65 years (OR 1.60; 95%CI 1.33-1.90), being managed in Haute-Savoie versus Isère or Savoie (OR 1.38; 95%CI 1.12-1.71), an arterial tension < 100mmHg (OR 1.73; 95%CI 1.27-2.35), a cardiogenic shock (OR 0.50; 95%CI 0.30-0.84), a pacemaker or left bundle branch block (OR 0.49; 95%CI 0.28-0.88), and an initial management outside the network (followed by treatment in an interventional centre in the network) (OR 0.62; 95%CI 0.40-0.94). Patients initially treated by mobile intensive care units were more often reperfused in accordance with recommendations when admitted < 3 (versus ≥ 3) h following symptom onset (adjusted OR 2.05; 95% CI 1.61-2.59), while those initially treated by in-hospital emergency units were less often reperfused in accordance with recommendation when treated < 3h following symptom onset (adjusted OR 0.67; 95% CI 0.46-0.97). In-hospital major adverse cardiac events (9.1% vs. 8.5%) and in-hospital mortality (6.4% vs. 5.1%) were not significantly different between patients reperfused in accordance with (versus not) recommendations.
Forty percent of patients with STEMI were not reperfused with fibrinolysis or angioplasty in accordance with regional guidelines. Characterization of this population should allow us to improve guideline adherence.
Mots-clé
Aged, Angioplasty, Balloon, Coronary, Electrocardiography, Emergency Service, Hospital, Female, Fibrinolysis, France, Guideline Adherence, Hospital Mortality, Humans, Male, Middle Aged, Mobile Health Units, Multivariate Analysis, Myocardial Infarction/diagnosis, Myocardial Infarction/mortality, Myocardial Infarction/therapy, Myocardial Reperfusion/methods, Guidelines, Infarctus du myocarde avec sus-decalage du segment ST, Myocardial reperfusion, Recommandations, Reperfusion myocardiques, ST elevation myocardial infarction
Pubmed
Création de la notice
09/03/2021 12:35
Dernière modification de la notice
02/03/2022 7:35
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