title: Five-year evolution of reperfusion strategies and early mortality in patients with ST-segment elevation myocardial infarction in France.
abstract: OBJECTIVE
  To assess 5-year evolutions in reperfusion strategies and early mortality in patients with ST-segment elevation myocardial infarction.
  
  
  RESULTS
  Using data from the French RESCUe network, we studied patients with ST-segment elevation myocardial infarction treated in mobile intensive care units between 2009 and 2013. Among 2418 patients (median age 62 years; 78.5% male), 2119 (87.6%) underwent primary percutaneous coronary intervention and 299 (12.4%) pre-hospital thrombolysis (94.0% of whom went on to undergo percutaneous coronary intervention). Use of primary percutaneous coronary intervention increased from 78.4% in 2009 to 95.9% in 2013 ( Ptrend<0.001). Median delays included: first medical contact to percutaneous coronary intervention centre 48 minutes; first medical contact to balloon inflation 94 minutes; and percutaneous coronary intervention centre to balloon inflation 43 minutes. Times from symptom onset to first medical contact and first medical contact to thrombolysis remained stable during 2009-2013, but times from symptom onset to first balloon inflation, and first medical contact to percutaneous coronary intervention centre to first balloon inflation decreased ( P<0.001). Among patients with known timings, 2146 (89.2%) had a first medical contact to percutaneous coronary intervention centre delay ⩽90 minutes, while 260 (10.8%) had a longer delay, with no significant variation over time. Primary percutaneous coronary intervention use increased over time in both delay groups, but was consistently higher in the ⩽90 versus >90 minutes delay group (83.0% in 2009 to 97.7% in 2013; Ptrend<0.001 versus 34.1% in 2009 to 79.2% in 2013; Ptrend<0.001). In-hospital (4-6%) and 30-day (6-8%) mortalities remained stable from 2009 to 2013.
  
  
  CONCLUSIONS
  In the RESCUe network, the use of primary percutaneous coronary intervention increased from 2009 to 2013, in line with guidelines, but there was no evolution in early mortality.
authors.affiliation: 1 Emergency Department and RESCUe Network, Lucien Hussel Hospital, France.
authors.forename: Carlos
authors.initials: C
authors.lastname: El Khoury
authors.affiliation: 2 Intensive care Unit, Louis Pradel Hospital, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bochaton
authors.affiliation: 3 RESCUe Network, Lucien Hussel Hospital, France.
authors.forename: Elodie
authors.initials: E
authors.lastname: Flocard
authors.affiliation: 4 Emergency Department and RESCUe Network, Fleyriat Hospital, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Serre
authors.affiliation: 2 Intensive care Unit, Louis Pradel Hospital, France.
authors.forename: Danka
authors.initials: D
authors.lastname: Tomasevic
authors.affiliation: 5 Centre d'Investigation Clinique (CIC) de Lyon, Louis Pradel Hospital, France.
authors.forename: Nathan
authors.initials: N
authors.lastname: Mewton
authors.affiliation: 2 Intensive care Unit, Louis Pradel Hospital, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Bonnefoy-Cudraz
mesh_terms: D000368:Aged; D004562:Electrocardiography; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D015425:Myocardial Reperfusion / Q000592:standards*; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors
keywords: ST-segment elevation myocardial infarction; mobile intensive care units; mortality; primary percutaneous coronary intervention; thrombolysis