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Decision to deploy coronary reperfusion is not affected by the volume of ST-segment elevation myocardial infarction patients managed by prehospital emergency medical teams

Lapostolle, Frédérica,b,c; Bataille, Sophied; Loyeau, Aurélien; Laborne, François-Xavierh; Dupas, Françoisi; Boche, Thévyj; Lamhaut, Lionele; Pirès, Virginiek; Lefort, Huguesf; Mapouata, Mireilled; Le Bail, Gaëllel; Weisslinger, Lisaa,c; Juliard, Jean-Michelg; Lambert, Yvesm for the e-MUST Registry Investigators

doi: 10.1097/MEJ.0000000000000586
Original article: PDF Only
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Objective 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.

Methods 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.

Results 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%).

Conclusion 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: frederic.lapostolle@aphp.fr

Received July 11, 2017

Accepted May 1, 2018

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