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Boiffard E, Dimet J, Baron O, Billon O, Boivineau C, Charvet M, Doizon T, Federspiel C, Flori M, Georges JL, Haddad G, Lipp D, Nguyen JO, Mouhoub D, Pernollet P, Philippot M, Pouliquen H, Roy N, Trebouet E, Turlotte G, Zeninari B, Orion L. [An independent observatory in Vendée on ST-elevated acute myocardial infarction (the OVISCA Register). A Departmental evaluation of demographic trends, mortality and delays before treatment]. Ann Cardiol Angeiol (Paris) 2019; 68:300-305. [PMID: 31542204 DOI: 10.1016/j.ancard.2019.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 08/28/2019] [Indexed: 11/17/2022]
Abstract
AIM Mortality from acute myocardial infarction has been falling during the past 30 years. The aim of the study was to evaluate the temporal trends of demographics, mortality rates, and time to treatment in patients admitted for acute ST elevation myocardial infarction (STEMI) in Vendée. PATIENTS AND METHODS From 2008 to 2016, 1994 patients hospitalised in CHD Vendée for STEMI <48hours were included. Two groups were compared, 838 patients admitted between 2008 and 2011 (group 1), and 1156 admitted between 2013 and 2016 (group 2). RESULTS Between the 2 periods, mean age was comparable (63.8 vs. 64.4 years), the gender ratio decreased (from 3.15 to 2.79 ; P=0.25). The mean duration of hospital stay was 0.8 day shorter (P=0.008). Treatment at discharge was optimum in 97.5% patients versus 92% (P<0.001). Left ventricular ejection fraction was comparable (50.6% vs. 50.2%). There was a non-significant trend to a decrease in hospital mortality (from 6.3% to 4.4%; p=0.12), and 6-month mortality (from 6.9% to 5.9%; P=0.51). There was a reduction in the use of emergency call-outs (74.9% to 68.9%; P<0.01), but an increase in direct presentations from 44% to 48.7% (P<0.05). The time before calling was comparable (2.5hours vs. 2.3hours; P=04.7). The "door-to-balloon" time decreased (0.71 vs. 0.55hour; P<0.001). The mean time between pain and angioplasty increased (5.7 vs. 6.8hours; P<0.05). CONCLUSIONS In vendee, from 2011 to 2016, hospital and 6-month mortality of STEMI trend to decrease non-significantly. The door to balloon time decreased, although emergency call-out rates and delays did not. Considerable efforts are still required with respect to patient information and education. Our registry offers an excellent tool to improve practices, the aim being to ensure its integration in the CRAC-France PCI registry.
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Affiliation(s)
- E Boiffard
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France.
| | - J Dimet
- Clinical Research Centre, Mont-de-Marsan Hospital, 40000, Mont-de-Marsan, France
| | - O Baron
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - O Billon
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - C Boivineau
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - M Charvet
- Post-emergency medical monitoring, polyclinique de l'Europe, 44600 Saint-Nazaire, France
| | - T Doizon
- General medicine department, CHD Vendée, 85400, Luçon, France
| | - C Federspiel
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - M Flori
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - J-L Georges
- Service de cardiologie centre hospitalier de Versailles, 78150 Le Chesnay, France
| | - G Haddad
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - D Lipp
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - J-O Nguyen
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - D Mouhoub
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - P Pernollet
- Cardiology department, CH Côte-de-Lumière, 85100, Les Sables d'Olonne, France
| | - M Philippot
- Medical Information Service, CHD Vendée, 85000, La Roche-sur-Yon, France
| | - H Pouliquen
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - N Roy
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - E Trebouet
- Emergency Department, CHD Vendée, 85000, La Roche-sur-Yon, France
| | - G Turlotte
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - B Zeninari
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - L Orion
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
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Boivineau C, Orion L, Dimet J, Boiffard E. Indications for fibrinolysis in patients with ST-segment elevation myocardial infarction: From guidelines to practice. Ann Cardiol Angeiol (Paris) 2016; 65:377. [PMID: 27968766 DOI: 10.1016/j.ancard.2016.09.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND European guidelines on managing ST segment elevation myocardial infarction (STEMI) during the first 12hours recommend fibrinolysis when the time elapsing between the first medical contact and balloon time (FMCBT) is more than 120minutes. AIM To assess the real-life clinical efficacy of guidelines on fibrinolysis in managing STEMI and identify obstacles to their everyday implementation. METHODS An observational study based on a permanent registry of reperfusion strategies and timing among patients treated in a French general hospital for STEMI with chest pain lasting for less than two hours. Patients were enrolled between January 1st 2008 and December 31st 2014. RESULTS The study included 669 patients: 79 (11.8%) benefited from effective fibrinolysis followed by coronary arteriography (PCI) within 24hours, 445 (66.5%) underwent a primary PCI, 99 (14.8%) received a rescue PCI and 46 (6.9%) did not undergo revascularization. The FMCBT was 120minutes or longer in 209 patients: fibrinolysis was performed in 68 of these patients (32.5%), and primary PCI in 141 (114 (54.6%) without contraindications to fibrinolysis and 27 (12.9%) with contraindications). The patient's age, female gender, co-morbidities and clinical management were factors that appeared to be linked to poor compliance with the guidelines, but none were significant (P>00.5). Nor were there significant differences regarding bleeding complications between patients receiving fibrinolysis or primary PCI (P>0.05). CONCLUSION The guidelines on fibrinolysis were not followed in 54.6% of patients when the FMCBT was more than 120minutes. Some criteria (age, gender, co-morbidities) may have been responsible for this non-compliance, although underestimating the time between first medical contact and arrival in the catheterisation laboratory could not be excluded. Further studies are necessary to improve estimates of this delay.
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Affiliation(s)
- C Boivineau
- Cardiologie, CHD de Vendée, 85000 La Roche-sur-Yon, France.
| | - L Orion
- Cardiologie, CHD de Vendée, 85000 La Roche-sur-Yon, France
| | - J Dimet
- Recherche clinique, CHD de Vendée, 85000 La Roche-sur-Yon, France
| | - E Boiffard
- Cardiologie, CHD de Vendée, 85000 La Roche-sur-Yon, France
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