- 作者：Nicole Karam ; Yves Lambert ; Muriel Tafflet ; Sophie Bataille ; Hakim Benamer ; Christophe Caussin ; Philippe Garot ; Sylvie Escolano ; Fran莽oise Boutot ; Agn猫s Greffet ; Jean-Yves Letarnec ; Georges-Antoine Capitani ; Fran莽ois Templier ; Claude Lap ; ry ; Arnold Auger ; Fran莽ois Dupas ; St茅phane Dubourdieu ; Jean-Michel Juliard ; Christian Spaulding ; Xavier Jouven ; et al.
- 关键词：Acute coronary syndromes ; Acute myocardial infarction ; Catheter based coronary interventions ; Fibrinolysis
- 刊名：International Journal of Cardiology
- 出版年：15 October, 2013
- 年：2013
- 卷：168
- 期：6
- 页码：5149-5155
- 全文大小：858 K
Background
ESC guidelines recommend a shorter (90 min) delay for the use of primary percutaneous intervention (pPCI) in patients presenting within the first 2 h of pain onset. Using registry data on STEMI patients in the Greater Paris Area, we assessed changes between 2003 and 2008 in the rates of pPCI, pre-hospital fibrinolytic therapy (PHF) and time delays in patients presenting within 2 h of STEMI pain onset.Methods
The Greater Paris Area was divided in 3 regions: Paris, the small and large rings. Patients were divided in three groups according to their reperfusion strategy: a) PHF, b) timely pPCI (FMC to balloon inflation time < 90 min), and c) late pPCI (FMC to balloon inflation time > 90 min).
Results
Among the 5592 patients included, 1695 (39%) had PHF, 1266 (29%) had timely pPCI, and 1415 (32%) had late pPCI. Over the 6 years, there was a sharp increase in timely pPCI in all regions, balanced by a decrease in PHF. The rate of late pPCI remained globally stable, with a decrease in Paris, stabilization in the small ring, and an increase in the large ring, where the density of catheterization laboratories was the lowest. By multivariate analysis, using on-time pPCI as a reference group, mortality was higher in the PHF and late pPCI groups.
Conclusions
In areas with a low density of pPCI centers, efforts should be made to improve the timeliness of pPCI. Otherwise, PHF followed by an immediate transfer to a pPCI capable hospital may be considered.