[Variations in the management of patients with acute myocardial infarction in alpine hospitals compared to other French hospitals. Secondary analysis of the USIC 2000 study data].
OBJECTIVE
To compare processes of care for acute myocardial infarction among patients admitted to alpine vs other French hospitals.


METHODS
Prospective observational study of patients with ST-elevation and non ST-elevation myocardial infarction of less than 48 hours hospitalized in 369 intensive care units in November 2000.


RESULTS
Fifty-five patients were enrolled in nine alpine hospitals and 2265 patients in 360 other French hospitals. Patients baseline characteristics did not differ between the two groups with the exception of ST-elevation myocardial infarction which was less frequent in patients admitted to alpine hospitals (71 vs. 83%, P = 0.02). Patients living in the alpine area were less likely to be admitted to hospitals with on-site cardiac catheterization facilities (42 vs. 60%, P < 0.01) although the use of primary (20%) and rescue (24%) percutaneous coronary intervention did not differ significantly between the two groups. There were no differences in the use of medical treatments between the two groups with the exception of low-molecular-weight heparin. The risk of in-hospital death and complications did not differ significantly between the two groups while the risk of death at one year was lower in patients admitted to alpine hospitals (5 vs. 16%, P = 0.04).


CONCLUSIONS
In 2000, a lower proportion of patients living in the alpine area had access to hospitals with cardiac catheterization facilities compared to other French patients. This finding supports the creation of an additional cardiac catheterization laboratory with experienced operators performing percutaneous coronary interventions 24 hours/7 days and the implementation of an emergency medical care network for acute coronary syndromes in the alpine area.
Belle
L
L
Réseau des urgences coronariennes (Resurcor), réseau nord-alpin des urgences, centre hospitalier de la région d'Annecy, Annecy, France. lbelle@ch-annecy.fr
Labarere
J
J
Fourny
M
M
Cambou
J P
JP
Danchin
N
N
D000368:Aged; D000531:Altitude; D015906:Angioplasty, Balloon, Coronary; D000925:Anticoagulants / Q000627:therapeutic use; D006328:Cardiac Catheterization; D003325:Coronary Care Units / Q000706:statistics & numerical data*; D004562:Electrocardiography; D005260:Female; D005602:France; D006493:Heparin / Q000627:therapeutic use; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate
D000925:Anticoagulants; D006493:Heparin