[Impact of the mode of arrival in the emergency department for patients with a STEMI and the clinical outcomes in terms of ejection fraction and survival].
Emergency Medical Services (EMSs) play a key role in the recognition and treatment of ST-segment elevation myocardial infarction (STEMI). This study evaluates patient outcome according to his mode of arrival in the care unit dealing with acute coronary syndromes.


METHODS
Retrospective analysis of STEMI infarctions registered by the Belgian Interdisciplinary Working Group on Acute Cardiology (BIWAC) at Saint-Pierre University Hospital, Brussels (C.H.U. Saint-Pierre), between 01/01/2005 and 31/12/2006. Comparison of two groups according to their arrival in the care system: group 1: brought in following an emergency call by mobile medical team (SMUR) or normal ambulance ; group 2: arrived at the hospital by their own means and classic admission to Emergency Service.
descriptive patient characteristics, localisation of the infarction and survival to the end of hospitalization, to six months and to one year.


RESULTS
Among 136 patients, 56.6 % arrived by EMS and 43.4 % by their own means. Patients who arrived by EMS were older (p = 0.008) and had a higher Killip score (p < 0.05). Pain-to-Angiography and Door-to-Angiography intervals were shorter in patients who arrived by EMS (222 vs 416 mins, p < 0.0001 and 62.6 vs 147 mins, p < 0.0001, respectively). There were no differences in the left ventricular ejection fraction (LVEF) and survival. However, for patients suffering an IVA attack, survival to six months and one year was better in the EMS group (88.9% vs 78.3%, p < 0.05 and 80.5 % vs 69.6 %, p = 0.05). In conclusion, dealing with STEMI infarctions is quicker by EMS admission. The infarctions admitted by this way are more serious. Wherever STEMI infarctions were localised, no improvement of LV function and survival was observed according to the mode of arrival, contrary to the subgroup with an IVA attack where survival is better at six months and one year by EMS admission.
Rousseaux
C
C
Service des Urgences et du SMUR, CHU Saint-Pierre, Bruxelles. croussea@ulb.ac.be
Briki
R
R
de Marneffe
M
M
Vandenbossche
J-L
JL
Mols
P
P
Claessens
B
B
D000368:Aged; D000552:Ambulances; D001530:Belgium; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000503:physiopathology; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology*; D013997:Time Factors