title: [Reperfusion in ST elevation myocardial infarction. From the guidelines to practice].
abstract: BACKGROUND
  International guidelines have recommendations for selecting the type of reperfusion (fibrinolysis or angioplasty) in the setting of ST-segment elevation myocardial infarction (STEMI), and suggest that emergency-care networks adapt these recommendations according to the local environment.
  
  
  OBJECTIVE
  To assess the proportions of STEMI patients treated with fibrinolysis or angioplasty in accordance with regional guidelines.
  
  
  METHODS
  Observational study based on a permanent registry of patients with STEMI of <12h duration in an emergency network in the French North Alps (Isère, Savoie, Haute-Savoie) from January 2009 to December 2012.
  
  
  RESULTS
  The registry included 2620 patients. Reperfusion was given in 2425/2620 (93%) of patients. Reperfusion type was in accordance with recommendations in 1567/2620 (60%) patients. Guideline-recommended fibrinolysis and angioplasty were performed in 47% (656/1385) and 79% (911/1149) respectively, of patients. In multivariable analysis, variables independently associated with guideline-recommended reperfusion were: an age < 65 years (OR 1.60; 95%CI 1.33-1.90), being managed in Haute-Savoie versus Isère or Savoie (OR 1.38; 95%CI 1.12-1.71), an arterial tension < 100mmHg (OR 1.73; 95%CI 1.27-2.35), a cardiogenic shock (OR 0.50; 95%CI 0.30-0.84), a pacemaker or left bundle branch block (OR 0.49; 95%CI 0.28-0.88), and an initial management outside the network (followed by treatment in an interventional centre in the network) (OR 0.62; 95%CI 0.40-0.94). Patients initially treated by mobile intensive care units were more often reperfused in accordance with recommendations when admitted < 3 (versus ≥ 3) h following symptom onset (adjusted OR 2.05; 95% CI 1.61-2.59), while those initially treated by in-hospital emergency units were less often reperfused in accordance with recommendation when treated < 3h following symptom onset (adjusted OR 0.67; 95% CI 0.46-0.97). In-hospital major adverse cardiac events (9.1% vs. 8.5%) and in-hospital mortality (6.4% vs. 5.1%) were not significantly different between patients reperfused in accordance with (versus not) recommendations.
  
  
  CONCLUSIONS
  Forty percent of patients with STEMI were not reperfused with fibrinolysis or angioplasty in accordance with regional guidelines. Characterization of this population should allow us to improve guideline adherence.
authors.affiliation: Médecins de Montagne Rhône-Alpes, 256, rue de la République, 73000 Chambery, France.
authors.forename: A
authors.initials: A
authors.lastname: Duraffourg
authors.affiliation: Service de cardiologie, CHU Campus, 03 BP 30284, Lomé, Togo.
authors.forename: K
authors.initials: K
authors.lastname: Yayehd
authors.affiliation: Unité d'évaluation médicale, CHU, 38000 Grenoble, France.
authors.forename: M
authors.initials: M
authors.lastname: Fourny
authors.affiliation: Service d'aide médicale urgente, centre hospitalier, 73000 Chambery, France.
authors.forename: J
authors.initials: J
authors.lastname: Turk
authors.affiliation: Unité d'évaluation médicale, CHU, 38000 Grenoble, France.
authors.forename: M
authors.initials: M
authors.lastname: Massoutier
authors.affiliation: Service d'aide médicale urgente, centre hospitalier, 74000 Annecy, France.
authors.forename: F X
authors.initials: FX
authors.lastname: Ageron
authors.affiliation: Service d'aide médicale urgente, CHU, 38000 Grenoble, France.
authors.forename: G
authors.initials: G
authors.lastname: Debaty
authors.affiliation: Réseau nord Alpin des urgences, centre hospitalier, 74000 Annecy, France.
authors.forename: C
authors.initials: C
authors.lastname: Ricard
authors.affiliation: Service de cardiologie, CHU, 38000 Grenoble, France.
authors.forename: G
authors.initials: G
authors.lastname: Vanzetto
authors.affiliation: Service de cardiologie, centre hospitalier, 74000 Annecy, France. Electronic address: loic.belle@wanadoo.fr.
authors.forename: L
authors.initials: L
authors.lastname: Belle
authors.affiliation: Unité d'évaluation médicale, CHU, 38000 Grenoble, France.
authors.forename: J
authors.initials: J
authors.lastname: Labarere
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D005342:Fibrinolysis; D005602:France; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008952:Mobile Health Units; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods*
keywords: Guidelines; Infarctus du myocarde avec sus-decalage du segment ST; Myocardial reperfusion; Recommandations; Reperfusion myocardiques; ST elevation myocardial infarction