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Boiffard E, Dimet J, Baron O, Billon O, Boivineau C, Charvet M, Doizon T, Federspiel C, Flori M, Georges JL, Haddad G, Lipp D, Nguyen JO, Mouhoub D, Pernollet P, Philippot M, Pouliquen H, Roy N, Trebouet E, Turlotte G, Zeninari B, Orion L. [An independent observatory in Vendée on ST-elevated acute myocardial infarction (the OVISCA Register). A Departmental evaluation of demographic trends, mortality and delays before treatment]. Ann Cardiol Angeiol (Paris) 2019; 68:300-305. [PMID: 31542204 DOI: 10.1016/j.ancard.2019.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 08/28/2019] [Indexed: 11/17/2022]
Abstract
AIM Mortality from acute myocardial infarction has been falling during the past 30 years. The aim of the study was to evaluate the temporal trends of demographics, mortality rates, and time to treatment in patients admitted for acute ST elevation myocardial infarction (STEMI) in Vendée. PATIENTS AND METHODS From 2008 to 2016, 1994 patients hospitalised in CHD Vendée for STEMI <48hours were included. Two groups were compared, 838 patients admitted between 2008 and 2011 (group 1), and 1156 admitted between 2013 and 2016 (group 2). RESULTS Between the 2 periods, mean age was comparable (63.8 vs. 64.4 years), the gender ratio decreased (from 3.15 to 2.79 ; P=0.25). The mean duration of hospital stay was 0.8 day shorter (P=0.008). Treatment at discharge was optimum in 97.5% patients versus 92% (P<0.001). Left ventricular ejection fraction was comparable (50.6% vs. 50.2%). There was a non-significant trend to a decrease in hospital mortality (from 6.3% to 4.4%; p=0.12), and 6-month mortality (from 6.9% to 5.9%; P=0.51). There was a reduction in the use of emergency call-outs (74.9% to 68.9%; P<0.01), but an increase in direct presentations from 44% to 48.7% (P<0.05). The time before calling was comparable (2.5hours vs. 2.3hours; P=04.7). The "door-to-balloon" time decreased (0.71 vs. 0.55hour; P<0.001). The mean time between pain and angioplasty increased (5.7 vs. 6.8hours; P<0.05). CONCLUSIONS In vendee, from 2011 to 2016, hospital and 6-month mortality of STEMI trend to decrease non-significantly. The door to balloon time decreased, although emergency call-out rates and delays did not. Considerable efforts are still required with respect to patient information and education. Our registry offers an excellent tool to improve practices, the aim being to ensure its integration in the CRAC-France PCI registry.
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Affiliation(s)
- E Boiffard
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France.
| | - J Dimet
- Clinical Research Centre, Mont-de-Marsan Hospital, 40000, Mont-de-Marsan, France
| | - O Baron
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - O Billon
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - C Boivineau
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - M Charvet
- Post-emergency medical monitoring, polyclinique de l'Europe, 44600 Saint-Nazaire, France
| | - T Doizon
- General medicine department, CHD Vendée, 85400, Luçon, France
| | - C Federspiel
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - M Flori
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - J-L Georges
- Service de cardiologie centre hospitalier de Versailles, 78150 Le Chesnay, France
| | - G Haddad
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - D Lipp
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - J-O Nguyen
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - D Mouhoub
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - P Pernollet
- Cardiology department, CH Côte-de-Lumière, 85100, Les Sables d'Olonne, France
| | - M Philippot
- Medical Information Service, CHD Vendée, 85000, La Roche-sur-Yon, France
| | - H Pouliquen
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - N Roy
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - E Trebouet
- Emergency Department, CHD Vendée, 85000, La Roche-sur-Yon, France
| | - G Turlotte
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - B Zeninari
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
| | - L Orion
- Cardiology department, CHD Vendée, Boulevard Moreau, 85000, La Roche-sur-Yon, France
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Trimmel H, Bayer T, Schreiber W, Voelckel WG, Fiedler L. Emergency management of patients with ST-segment elevation myocardial infarction in Eastern Austria: a descriptive quality control study. Scand J Trauma Resusc Emerg Med 2018; 26:38. [PMID: 29739432 PMCID: PMC5941459 DOI: 10.1186/s13049-018-0504-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/25/2018] [Indexed: 11/26/2022] Open
Abstract
Background Myocardial infarction is a time-critical condition and its outcome is determined by appropriate emergency care. Thus we assessed the efficacy of a supra-regional ST-segment elevation myocardial infarction (STEMI) network in Easternern Austria. Methods The Eastern Austrian STEMI network serves a population of approx. 766.000 inhabitants within a region of 4186 km2. Established in 2007, it now comprises 20 pre-hospital emergency medical service (EMS) units (10 of these physician-staffed), 4 hospitals and 3 cardiac intervention centres. Treatment guidelines were updated in 2012 and documentation within a web-based STEMI registry became mandatory. For this retrospective qualitative control study, data from February 2012–April 2015 was assessed. Results A total of 416 STEMI cases were documented, and 99% were identified by EMS within 6 (4.0–8.0) minutes after arrival. Median time loss between onset of pain and EMS call was 54 (20–135) minutes; response, pre-hospital and door-to-balloon times were 14 (10–20), 46 (37–59) and 45 (32–66) minutes, respectively. When general practitioners were involved, time between onset of pain and balloon inflation significantly increased from 180 (135–254) to 218 (155–348) minutes (p < .001). A pre-hospital time < 30 min was achieved in 25.8% of all patients during the day vs. 11.6% during the night (p < .001). Three hundred forty-five patients (83%) were subjected to primary percutaneous coronary intervention (PPCI), and 6.5% were thrombolysed by EMS. Pre-hospital complication rate was 18% (witnessed cardiac arrest 7%, threatening arrhythmias 6%, cardiogenic shock 5%). Twenty-four hours and hospital mortality rate were 1.2 and 2.8%, respectively. Discussion Optimal patient care and subsequently outcome of STEMI is strongly determined by a short patient-decision time to call EMS and by the first medical contact to balloon time (FMCBT). Supra-regional networks are key in order to increase the efficacy and efficiency of health care. The goal of 120 min FMCBT was achieved in 78% of our patients immediately managed by EMS, thus indicating room for improvement. Conclusion In conclusion, results from the Eastern Austrian STEMI network shed light on the necessity of increasing patient awareness in order to minimize any time loss derived by delayed EMS calls. Involvement of family physicians resulted in prolonged FMCBT. A stronger utilization of rescue helicopters could further improve the efficacy of this supra-regional network. Nevertheless PPCI rates, time intervals and outcome rates compare well with international benchmarks.
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Affiliation(s)
- Helmut Trimmel
- Department of Anesthesiology, Emergency and Critical Care Medicine, General Hospital Wiener Neustadt, Corvinusring 3-5, A 2700, Wiener Neustadt, Austria. .,Karl Landsteiner Institute of Emergency Medicine, General Hospital Wiener Neustadt, Corvinusring 3-5, A 2700, Wiener Neustadt, Austria. .,Medical University Vienna, Vienna, Austria.
| | - Thomas Bayer
- Department of Anesthesiology, Emergency and Critical Care Medicine, General Hospital Wiener Neustadt, Corvinusring 3-5, A 2700, Wiener Neustadt, Austria
| | | | - Wolfgang G Voelckel
- Department of Anesthesiology and Critical Care Medicine, AUVA Trauma Center Salzburg, Salzburg, Austria.,University of Stavanger, Network for Medical Sciences, Stavanger, Norway.,Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Lukas Fiedler
- Department of Internal Medicine II, General Hospital Wiener Neustadt, Wiener Neustadt, Austria
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