Mortality in patients with ST-segment elevation myocardial infarction (STEMI) has been associated with the volume of activity of percutaneous coronary intervention (PCI) facilities. This observational study investigated whether the coronary reperfusion-decision rate is associated with the volume of activity in a prehospital emergency setting.
Prospectively collected data for the period 2003–2013 were extracted from a regional registry of all STEMI patients handled by eight dispatch centers (SAMUs) in and around Paris [41 mobile ICU (MICUs)]. A possible association between volume of activity (number of STEMIs) and coronary reperfusion-decision rate, and subsidiarily between volume of activity and choice of technique (fibrinolysis vs. primary PCI), were investigated. Explanatory factors (patient age, sex, delay between pain onset and first medical contact, and access to a PCI facility) were analyzed in a multivariate analysis.
Overall, 18 162 patients; male/female 3.5/1; median age 62 (52–72) years were included in the analysis. The median number of STEMIs per MICU was 339 (IQ 220–508) and that of reperfusion-decisions was 94% (91–95). There was no association between the decision rate and the number of STEMIs (P=0.1). However, the decision rate was associated with age, sex, delay, and access to a PCI facility (P<0.0001) in a highly significant way. Fibrinolysis was a more frequent option for low-volume (remoter PCI facilities) than high-volume MICUs (30 vs. 16%).
The decision of coronary reperfusion in a prehospital emergency setting depended on patient characteristics, delay between pain onset and first medical contact, and access to a PCI facility, but not on volume of activity. Promoting fibrinolysis use in underserved areas might help increase the reperfusion-decision rate.
aSAMU 93, UF Recherche-Enseignement-Qualité, Avicenne Hospital-APHP
bINSERM Unit 942, Bobigny
cUniversité Paris 13, Sorbonne Paris Cité
dRegistry Department, Regional Health Agency in Great Paris Area
eSAMU 75, Necker Hospital-APHP
fEMS Department, Fire Department of Paris
gCardiology Department, Bichat Hospital-APHP, DHU FIRE, Université Paris Diderot, Sorbonne Paris-Cité, INSERM U-1148 Paris
hSAMU 91, Sud Francilien Hospital, Corbeil-Essonnes
iSAMU 95, Pontoise Hospital, Pontoise
jSAMU 94, Mondor Hospital-APHP, Créteil
kSAMU 77, Melun Hospital, Melun
lSAMU 92, Garches Hospital-APHP, Garches
mSAMU 78, Versailles Hospital, Le Chesnay
nGCS SESAN, Information Processing Department, Paris, France
Correspondence to Frédéric Lapostolle, PhD, SAMU 93, UF Recherche-Enseignement-Qualité, Université Paris 13, Sorbonne Paris Cité, Inserm U942, Hôpital Avicenne, 125, rue de Stalingrad, 93009 Bobigny, France Tel: +33 148 964 454; fax: +33 148 964 493; e-mail: email@example.com
Received July 11, 2017
Accepted May 1, 2018