title: Prognostic impact of non-compliance with guidelines-recommended times to reperfusion therapy in ST-elevation myocardial infarction. The FAST-MI 2010 registry.
abstract: OBJECTIVE
  Current guidelines recommend short time delays from qualifying ECG to reperfusion therapy in ST-elevation myocardial infarction (STEMI) patients. Recently, however, it has been suggested that shortening door-to-balloon times might not result in lower mortality, thereby questioning the relevance of current guidelines. The aim of this study was to assess in-hospital and one-year mortality in patients with fibrinolysis or primary percutaneous coronary intervention (PPCI) according to guidelines-recommended times to reperfusion therapy.
  
  
  RESULTS
  FAST-MI 2010 is a nationwide French registry including 4169 patients, of whom 1580 had ST-elevation myocardial infarction and had PPCI ( n=1289) or fibrinolysis ( n=291) as part of a pharmaco-invasive strategy. Four groups were constituted: Gr1 (within recommended times from ECG to PPCI; n=708), Gr2 (beyond recommended times from ECG to PPCI; n=581), Gr3 (time from ECG to lysis ⩽30 min, n=196), and Gr4 (time from ECG to lysis >30 min, n=95). In-hospital mortality was 3.6% in Gr2 vs. 1.0% in Gr1 and 3.2% in Gr4 vs. 1.0% in Gr3. After adjustment, hospital mortality was higher for reperfusion therapy beyond recommended times: odds ratio (OR) 3.29, 95% confidence interval (CI) 1.32-8.18; for PPCI, OR: 4.13; 95% CI: 1.50-11.35 and for fibrinolysis, OR: 2.72; 95% CI: 0.34-21.96. Likewise, one-year mortality was higher in patients with reperfusion beyond recommended times (hazard ratio 2.13, 95% CI:1.29-3.50). The results were confirmed by propensity score analyses.
  
  
  CONCLUSIONS
  Early and one-year mortality were lower for ST-elevation myocardial infarction patients when the recommended timelines for reperfusion therapy were met, suggesting that, in spite of recent interrogations, compliance with current guidelines remains a clinically relevant objective.
authors.affiliation: 1 Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, France; Université Paris-Descartes, France.|2 INSERM U-970, Paris, France.
authors.forename: Etienne
authors.initials: E
authors.lastname: Puymirat
authors.affiliation: 1 Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, France; Université Paris-Descartes, France.
authors.forename: Julia
authors.initials: J
authors.lastname: Caudron
authors.affiliation: 3 AP-HP, Hôpital Bichat, Paris, France; Université Paris-Diderot, Sorbonne Paris-Cité, France; INSERM U-698, Paris, France.
authors.forename: Philippe G
authors.initials: PG
authors.lastname: Steg
authors.affiliation: 4 Hospital Regional University of Lille, Department of Cardiology, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Lemesle
authors.affiliation: 5 University Hospital Centre, Hospital of Bocage, Dijon, France.
authors.forename: Yves
authors.initials: Y
authors.lastname: Cottin
authors.affiliation: 6 University Hospital of Bordeaux, Hospital Haut Leveque, Department of Cardiology, Bordeaux-Pessac, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Coste
authors.affiliation: 7 University Hospital Jean Minjoz, Department of Cardiology, Besançon, France.
authors.forename: François
authors.initials: F
authors.lastname: Schiele
authors.affiliation: 8 Clinique du Pont de Chaume, Montauban, France.
authors.forename: Axel
authors.initials: A
authors.lastname: de Labriolle
authors.affiliation: 9 Toulouse Rangueil University Hospital, Department of Cardiology, France; UMR1027, INSERM, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Bataille
authors.affiliation: 9 Toulouse Rangueil University Hospital, Department of Cardiology, France; UMR1027, INSERM, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Ferrières
authors.affiliation: 10 AP-HP, Hôpital Saint Antoine, Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST), Paris, France; Université Pierre et Marie Curie (UPMC-Paris 06), France.
authors.forename: Tabassome
authors.initials: T
authors.lastname: Simon
authors.affiliation: 1 Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, France; Université Paris-Descartes, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
mesh_terms: D000368:Aged; D005260:Female; D005342:Fibrinolysis; D005602:France; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion / Q000379:methods* / Q000401:mortality; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000401:mortality; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012042:Registries; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality* / Q000601:surgery*; D016019:Survival Analysis; D061665:Time-to-Treatment; D016896:Treatment Outcome
keywords: Acute myocardial infarction; ST-elevation myocardial infarction; coronary artery disease; reperfusion therapy