title: [Evolution since 2002 of the management of patients with ST elevated acute coronary syndrome (STEMI) in Île-de-France. E-MUST survey].
abstract: BACKGROUND
  ST-segment-elevation acute myocardial infarction (STEMI) is a therapeutic emergency. Early reperfusion is the key to successful reperfusion. Guidelines recommend organizing regional networks. In France, this starts with a call to a medical dispatch center, the SAMU-centre 15. The aim of this study was to evaluate regional STEMI management using data collected from 2002 to 2010.
  
  
  METHODS
  Observational, prospective, multicenter survey. STEMI patient with chest pain lasting for less than 24hours managed by 40 mobile emergency and resuscitation service (SMUR) and 8 emergency medical system (SAMU) from the Greater Paris Area (Île-de-France) were analyzed. Demographic data, cardiovascular risk factors, infarction location, decision of reperfusion and delays were collected. The rate of coronary reperfusion was chosen as the primary endpoint.
  
  
  RESULTS
  Eleven thousand five hundred and eighty-eight patients enrolled from 2002 to 2010 were analyzed. Median age was 59.9 (51.0 to 72.9) years; 9080 (78.5%) were men. The number of patients included decreased from 1376 in 2002 to 1119 in 2010. Reperfusion was achieved by fibrinolysis in 2644 (23%) cases and primary angioplasty in 7999 (69%) cases. The rate of decision of coronary reperfusion significantly increased from 86.7% in 2002 to 94.8% in 2010 (P<0.0001). Interaction between the increasing decision of reperfusion and all factors studied (demographics, cardiovascular risk factors, infarct location and delays) was significant only for family history of coronary artery disease (P=0.03). In-hospital mortality was 2.8% (321 cases).
  
  
  CONCLUSIONS
  The number of patients with STEMI managed by the SAMU declined slightly over the past decade. The rate of decision of reperfusion progressively increased up to 95%. Entrance into the network by the SAMU-centre 15 is a guarantee of a wide and early access to the coronary reperfusion.
authors.affiliation: Assistance Publique-Hôpitaux de Paris, SAMU 93 - UF Recherche-Enseignement-Qualité, Université Paris 13, Sorbonne Paris Cité, Inserm U942, 93009 Bobigny, France; Université Paris 13, Sorbonne Paris Cité, EA 3509, 93000 Bobigny, France. Electronic address: frederic.lapostolle@avc.aphp.fr.
authors.forename: Frédéric
authors.initials: F
authors.lastname: Lapostolle
authors.affiliation: Siège de l'AP-HP, service des registres ARS Île-de-France, 75004 Paris, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Bataille
authors.affiliation: Centre de recherche cardiovasculaire PARCC, Inserm U970, 75015 Paris, France.
authors.forename: Muriel
authors.initials: M
authors.lastname: Tafflet
authors.affiliation: Centre hospitalier de Pontoise, SAMU 95, 95301 Pontoise, France.
authors.forename: François
authors.initials: F
authors.lastname: Dupas
authors.affiliation: Centre hospitalier Sud Francilien, SAMU 91, 91106 Corbeil-Essonnes, France.
authors.forename: François
authors.initials: F
authors.lastname: Laborne
authors.affiliation: Siège de l'AP-HP, service des registres ARS Île-de-France, 75004 Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Mouranche
authors.affiliation: Brigade des sapeurs-pompiers de Paris, service médical, 75017 Paris, France.
authors.forename: Hugues
authors.initials: H
authors.lastname: Lefort
authors.affiliation: Assistance Publique-Hôpitaux de Paris, hôpital Bichat, service de cardiologie, 75018 Paris, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Juliard
authors.affiliation: Centre hospitalier de Melun, SAMU 77, 77011 Melun, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Letarnec
authors.affiliation: Siège de l'AP-HP, service des registres ARS Île-de-France, 75004 Paris, France.
authors.forename: Mireille
authors.initials: M
authors.lastname: Mapouata
authors.affiliation: Assistance Publique-Hôpitaux de Paris, hôpital Necker, SAMU 75, 75015 Paris, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Lamhaut
authors.affiliation: Assistance Publique-Hôpitaux de Paris, hôpital Raymond-Poincaré, SAMU 92, 92380 Garches, France.
authors.forename: Séverine
authors.initials: S
authors.lastname: Cahun-Giraud
authors.affiliation: Assistance Publique-Hôpitaux de Paris, hôpital Henri-Mondor, SAMU 94, 94100 Créteil, France.
authors.forename: Thévy
authors.initials: T
authors.lastname: Boche
authors.affiliation: Assistance Publique-Hôpitaux de Paris, hôpital Necker, SAMU 75, 75015 Paris, France.
authors.forename: Patricia
authors.initials: P
authors.lastname: Jabre
authors.affiliation: Centre de recherche cardiovasculaire PARCC, Inserm U970, 75015 Paris, France; Assistance Publique-Hôpitaux de Paris, hôpital européen Georges-Pompidou, 75015 Paris, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Spaulding
authors.affiliation: Centre de recherche cardiovasculaire PARCC, Inserm U970, 75015 Paris, France; Assistance Publique-Hôpitaux de Paris, hôpital européen Georges-Pompidou, 75015 Paris, France.
authors.forename: Xavier
authors.initials: X
authors.lastname: Jouven
authors.affiliation: Centre hospitalier de Versailles, SAMU 78, 78157 Le Chesnay, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Lambert
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000503:physiopathology / Q000628:therapy*; D000368:Aged; D000552:Ambulances / Q000706:statistics & numerical data; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000379:methods / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion / Q000706:statistics & numerical data; D010297:Paris / Q000453:epidemiology; D011795:Surveys and Questionnaires; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data