title: Indications for fibrinolysis in patients with ST-segment elevation myocardial infarction: From guidelines to practice.
abstract: BACKGROUND
  European guidelines on managing ST segment elevation myocardial infarction (STEMI) during the first 12hours recommend fibrinolysis when the time elapsing between the first medical contact and balloon time (FMCBT) is more than 120minutes.
  
  
  OBJECTIVE
  To assess the real-life clinical efficacy of guidelines on fibrinolysis in managing STEMI and identify obstacles to their everyday implementation.
  
  
  METHODS
  An observational study based on a permanent registry of reperfusion strategies and timing among patients treated in a French general hospital for STEMI with chest pain lasting for less than two hours. Patients were enrolled between January 1st2008 and December 31st2014.
  
  
  RESULTS
  The study included 669 patients: 79 (11.8%) benefited from effective fibrinolysis followed by coronary arteriography (PCI) within 24hours, 445 (66.5%) underwent a primary PCI, 99 (14.8%) received a rescue PCI and 46 (6.9%) did not undergo revascularization. The FMCBT was 120minutes or longer in 209 patients: fibrinolysis was performed in 68 of these patients (32.5%), and primary PCI in 141 (114 (54.6%) without contraindications to fibrinolysis and 27 (12.9%) with contraindications). The patient's age, female gender, co-morbidities and clinical management were factors that appeared to be linked to poor compliance with the guidelines, but none were significant (P>00.5). Nor were there significant differences regarding bleeding complications between patients receiving fibrinolysis or primary PCI (P>0.05).
  
  
  CONCLUSIONS
  The guidelines on fibrinolysis were not followed in 54.6% of patients when the FMCBT was more than 120minutes. Some criteria (age, gender, co-morbidities) may have been responsible for this non-compliance, although underestimating the time between first medical contact and arrival in the catheterisation laboratory could not be excluded. Further studies are necessary to improve estimates of this delay.
authors.affiliation: Cardiologie, CHD de Vendée, 85000 La Roche-sur-Yon, France. Electronic address: claire.boivineau@outlook.fr.
authors.forename: C
authors.initials: C
authors.lastname: Boivineau
authors.affiliation: Cardiologie, CHD de Vendée, 85000 La Roche-sur-Yon, France.
authors.forename: L
authors.initials: L
authors.lastname: Orion
authors.affiliation: Recherche clinique, CHD de Vendée, 85000 La Roche-sur-Yon, France.
authors.forename: J
authors.initials: J
authors.lastname: Dimet
authors.affiliation: Cardiologie, CHD de Vendée, 85000 La Roche-sur-Yon, France.
authors.forename: E
authors.initials: E
authors.lastname: Boiffard
mesh_terms: D017023:Coronary Angiography; D004632:Emergency Medical Services; D005260:Female; D005602:France; D019983:Guideline Adherence; D006769:Hospitals, General; D006801:Humans; D008297:Male; D012042:Registries; D000072657:ST Elevation Myocardial Infarction / Q000188:drug therapy*; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome