title: Changes in reperfusion strategy over time for ST segment elevation myocardial infarction in the Greater Paris Area: results from the e-MUST Registry.
abstract: BACKGROUND
  ESC guidelines recommend a shorter (90 min) delay for the use of primary percutaneous intervention (pPCI) in patients presenting within the first 2h of pain onset. Using registry data on STEMI patients in the Greater Paris Area, we assessed changes between 2003 and 2008 in the rates of pPCI, pre-hospital fibrinolytic therapy (PHF) and time delays in patients presenting within 2h of STEMI pain onset.
  
  
  METHODS
  The Greater Paris Area was divided in 3 regions: Paris, the small and large rings. Patients were divided in three groups according to their reperfusion strategy: a) PHF, b) timely pPCI (FMC to balloon inflation time < 90 min), and c) late pPCI (FMC to balloon inflation time > 90 min).
  
  
  RESULTS
  Among the 5592 patients included, 1695 (39%) had PHF, 1266 (29%) had timely pPCI, and 1415 (32%) had late pPCI. Over the 6 years, there was a sharp increase in timely pPCI in all regions, balanced by a decrease in PHF. The rate of late pPCI remained globally stable, with a decrease in Paris, stabilization in the small ring, and an increase in the large ring, where the density of catheterization laboratories was the lowest. By multivariate analysis, using on-time pPCI as a reference group, mortality was higher in the PHF and late pPCI groups.
  
  
  CONCLUSIONS
  In areas with a low density of pPCI centers, efforts should be made to improve the timeliness of pPCI. Otherwise, PHF followed by an immediate transfer to a pPCI capable hospital may be considered.
authors.affiliation: Cardiology Department, Hôpital Européen Georges Pompidou (Assistance Publique-Hôpitaux de Paris), and Paris Descartes University, Paris, France; INSERM, U970, Paris Cardiovascular Research Center - PARCC, Paris, France.
authors.forename: Nicole
authors.initials: N
authors.lastname: Karam
authors.forename: Yves
authors.initials: Y
authors.lastname: Lambert
authors.forename: Muriel
authors.initials: M
authors.lastname: Tafflet
authors.forename: Sophie
authors.initials: S
authors.lastname: Bataille
authors.forename: Hakim
authors.initials: H
authors.lastname: Benamer
authors.forename: Christophe
authors.initials: C
authors.lastname: Caussin
authors.forename: Philippe
authors.initials: P
authors.lastname: Garot
authors.forename: Sylvie
authors.initials: S
authors.lastname: Escolano
authors.forename: Françoise
authors.initials: F
authors.lastname: Boutot
authors.forename: Agnès
authors.initials: A
authors.lastname: Greffet
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Letarnec
authors.forename: Georges-Antoine
authors.initials: GA
authors.lastname: Capitani
authors.forename: François
authors.initials: F
authors.lastname: Templier
authors.forename: Claude
authors.initials: C
authors.lastname: Lapandry
authors.forename: Arnold
authors.initials: A
authors.lastname: Auger
authors.forename: François
authors.initials: F
authors.lastname: Dupas
authors.forename: Stéphane
authors.initials: S
authors.lastname: Dubourdieu
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Juliard
authors.forename: Christian
authors.initials: C
authors.lastname: Spaulding
authors.forename: Xavier
authors.initials: X
authors.lastname: Jouven
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality / Q000592:standards*; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D010297:Paris / Q000453:epidemiology; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D015912:Thrombolytic Therapy / Q000401:mortality / Q000706:statistics & numerical data*; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D016896:Treatment Outcome
keywords: Acute coronary syndromes; Acute myocardial infarction; Catheter based coronary interventions; Fibrinolysis