title: [Evolution of the interventional reperfusion strategy and reperfusion times in acute ST-segment elevation myocardial infarction].
abstract: BACKGROUND
  In patients with acute ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI), the recommended times (first medical contact-to-balloon (M2B) <120 or <90min, and door-to-balloon (D2B) <45min) are reached in less than 50% of patients.
  
  
  OBJECTIVE
  To compare the interventional reperfusion strategy and reperfusion times between two series of consecutive STEMI patients referred for pPCI within 12hours of symptom onset, in 2007 and 2012.
  
  
  METHODS
  Retrospective study of 182 patients, 87 admitted from January 2007 to March 2008 (period 1), and 95 admitted from January to December 2012 (period 2). The procedural characteristics and the different times between onset of pain and mechanical reperfusion were gathered and compared by non-parametric tests.
  
  
  RESULTS
  Radial access, thromboaspiration, and drug eluting stents were more frequent, and cardiogenic shock was less common during period 2, compared with the period 1. The median time from first medical contact to balloon (M2B) decreased by 26% (135min, [quartiles: 113-183] in 2007 versus 100 [76-137] in 2012, P<0.001), in relation to the reduction in both prehospital times and time in the catheterization laboratory (D2B: 51 [44-65] and 44min [37-55], respectively, P<0.01).
  
  
  CONCLUSIONS
  The D2B and M2B times significantly decreased in our centre between 2007 and 2012, and reached the recommended values in >60% of the cases. This may be explained by better coordination between emergency medical units and interventional cardiologists, and by the presence of two paramedics in the catheterization laboratory for 24/24 7/7 pPCI since 2010 in France, in accordance with recent national regulation.
authors.affiliation: Unité de soins intensifs cardiologiques et cardiologie interventionnelle, service de cardiologie, hôpital André-Mignot, 177, rue de Versailles, 78157 Le Chesnay cedex, France.
authors.forename: S
authors.initials: S
authors.lastname: Azzaz
authors.affiliation: Unité de soins intensifs cardiologiques et cardiologie interventionnelle, service de cardiologie, hôpital André-Mignot, 177, rue de Versailles, 78157 Le Chesnay cedex, France.
authors.forename: C
authors.initials: C
authors.lastname: Charbonnel
authors.affiliation: Unité de soins intensifs cardiologiques et cardiologie interventionnelle, service de cardiologie, hôpital André-Mignot, 177, rue de Versailles, 78157 Le Chesnay cedex, France.
authors.forename: B
authors.initials: B
authors.lastname: Ajlani
authors.affiliation: Unité de soins intensifs cardiologiques et cardiologie interventionnelle, service de cardiologie, hôpital André-Mignot, 177, rue de Versailles, 78157 Le Chesnay cedex, France.
authors.forename: G
authors.initials: G
authors.lastname: Cherif
authors.affiliation: Unité de soins intensifs cardiologiques et cardiologie interventionnelle, service de cardiologie, hôpital André-Mignot, 177, rue de Versailles, 78157 Le Chesnay cedex, France.
authors.forename: R
authors.initials: R
authors.lastname: Convers
authors.affiliation: Unité de soins intensifs cardiologiques et cardiologie interventionnelle, service de cardiologie, hôpital André-Mignot, 177, rue de Versailles, 78157 Le Chesnay cedex, France.
authors.forename: E
authors.initials: E
authors.lastname: Blicq
authors.affiliation: Unité de soins intensifs cardiologiques et cardiologie interventionnelle, service de cardiologie, hôpital André-Mignot, 177, rue de Versailles, 78157 Le Chesnay cedex, France.
authors.forename: S
authors.initials: S
authors.lastname: Augusto
authors.affiliation: Unité de soins intensifs cardiologiques et cardiologie interventionnelle, service de cardiologie, hôpital André-Mignot, 177, rue de Versailles, 78157 Le Chesnay cedex, France.
authors.forename: G
authors.initials: G
authors.lastname: Gibault-Genty
authors.affiliation: Unité de soins intensifs cardiologiques et cardiologie interventionnelle, service de cardiologie, hôpital André-Mignot, 177, rue de Versailles, 78157 Le Chesnay cedex, France.
authors.forename: N
authors.initials: N
authors.lastname: Baron
authors.affiliation: Service d'accueil des urgences, hôpital André-Mignot, 78157 Le Chesnay, France.
authors.forename: M
authors.initials: M
authors.lastname: Koukabi
authors.affiliation: Unité de soins intensifs cardiologiques et cardiologie interventionnelle, service de cardiologie, hôpital André-Mignot, 177, rue de Versailles, 78157 Le Chesnay cedex, France.
authors.forename: S
authors.initials: S
authors.lastname: Almeida
authors.affiliation: Unité de soins intensifs cardiologiques et cardiologie interventionnelle, service de cardiologie, hôpital André-Mignot, 177, rue de Versailles, 78157 Le Chesnay cedex, France.
authors.forename: A
authors.initials: A
authors.lastname: Vienet-Legué
authors.affiliation: SAMU 78/SMUR, hôpital André-Mignot, centre hospitalier de Versailles, 78157 Le Chesnay, France.
authors.forename: S
authors.initials: S
authors.lastname: Da Costa
authors.affiliation: Unité de soins intensifs cardiologiques et cardiologie interventionnelle, service de cardiologie, hôpital André-Mignot, 177, rue de Versailles, 78157 Le Chesnay cedex, France.
authors.forename: G
authors.initials: G
authors.lastname: Galuscan
authors.affiliation: Unité de soins intensifs cardiologiques et cardiologie interventionnelle, service de cardiologie, hôpital André-Mignot, 177, rue de Versailles, 78157 Le Chesnay cedex, France.
authors.forename: J
authors.initials: J
authors.lastname: Schwob
authors.affiliation: Unité de soins intensifs cardiologiques et cardiologie interventionnelle, service de cardiologie, hôpital André-Mignot, 177, rue de Versailles, 78157 Le Chesnay cedex, France.
authors.forename: B
authors.initials: B
authors.lastname: Livarek
authors.affiliation: Unité de soins intensifs cardiologiques et cardiologie interventionnelle, service de cardiologie, hôpital André-Mignot, 177, rue de Versailles, 78157 Le Chesnay cedex, France. Electronic address: jgeorges@ch-versailles.fr.
authors.forename: J-L
authors.initials: JL
authors.lastname: Georges
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D015425:Myocardial Reperfusion; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies; D013997:Time Factors
keywords: Angioplastie primaire; Door-to-balloon time; Délai; Indicateurs de qualité; Infarctus aigu du myocarde; Myocardial infarction; Primary PCI; Quality indicators; Reperfusion; STEMI