title: Characteristics and management of acute ST-segment elevation myocardial infarctions occurring in ski resorts in the French Alps: Impact of an acute coronary care network.
abstract: BACKGROUND
  Compliance with guidelines for the management of ST-segment elevation myocardial infarction (STEMI) may be difficult in hard-to-access areas.
  
  
  OBJECTIVE
  to analyse the characteristics, management and outcome of STEMIs occurring at altitude in the French Alps and managed by mobile medical emergency units.
  
  
  METHODS
  From January 2006 to December 2008, from the prospective RESURCOR registry, 114 patients with a STEMI of less than 12 hours' duration, occurring in a ski resort or at high altitude and managed by the RESURCOR care system, were identified. Baseline characteristics, treatments and in-hospital outcomes were analysed.
  
  
  RESULTS
  Ninety-three per cent of patients were men; the mean age was 57 years. STEMIs occurred during or less than 1 hour after physical activity in 76.3% of cases (mainly during or after alpine/cross-country skiing). Killip class greater or equal to 2 and cardiac arrest were observed in 35% and 7.9% of cases, respectively. Fifty-two (45.6%) patients underwent thrombolysis and 62 (54.4%) had percutaneous coronary intervention (PCI). Median delays were: first call to treatment, 82 min (17-230 min); symptoms to treatment, 165 min (52-770 min). All delays were significantly longer for PCI than for thrombolysis. First call to treatment delay was less than 120 min in 98.1% of patients who underwent thrombolysis and in 51.6% who had PCI (P<0.0001). In-hospital survival was 96.5%.
  
  
  CONCLUSIONS
  Altitude STEMIs happen mainly during sporting activities. Clinical presentation is often severe, but an emergency coronary care network allows rapid reperfusion. These findings emphasize the need for an efficient network for STEMI management in geographically difficult-to-access areas.
authors.affiliation: Department of Cardiology, University Hospital, 38043 Grenoble cedex 09, France.
authors.forename: Mathieu
authors.initials: M
authors.lastname: Chacornac
authors.forename: Gilles
authors.initials: G
authors.lastname: Baronne-Rochette
authors.forename: Marie-Hélène
authors.initials: MH
authors.lastname: Schmidt
authors.forename: Dominique
authors.initials: D
authors.lastname: Savary
authors.forename: Daniel
authors.initials: D
authors.lastname: Habold
authors.forename: Hélène
authors.initials: H
authors.lastname: Bouvaist
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Marliere
authors.forename: Loic
authors.initials: L
authors.lastname: Belle
authors.forename: Jacques
authors.initials: J
authors.lastname: Machecourt
authors.forename: Gérald
authors.initials: G
authors.lastname: Vanzetto
mesh_terms: D000368:Aged; D000531:Altitude; D015906:Angioplasty, Balloon, Coronary; D016009:Chi-Square Distribution; D019033:Delivery of Health Care, Integrated; D004632:Emergency Medical Services; D005260:Female; D005602:France; D019983:Guideline Adherence; D006297:Health Services Accessibility; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D005082:Physical Exertion; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012621:Seasons; D012720:Severity of Illness Index; D012865:Skiing; D015996:Survival Rate; D015912:Thrombolytic Therapy; D013997:Time Factors; D014187:Transportation of Patients; D016896:Treatment Outcome