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Cetran L, Lesaine E, Miganeh-Hadi S, Sevin F, Saillour-Glenisson F, Pradeau C, Coste P. Socioeconomic status influences delays in the management of acute ST-elevation myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
A prompt diagnosis to initiate the appropriate reperfusion therapy is crucial to improve clinical outcomes in acute ST-elevation myocardial infarction (STEMI) patients. Socio-economic status (SES) refers to parameters like income, educational status and occupation. A low SES negatively interferes with the prognosis of STEMI patients. However, the impact of SES on delay time in acute STEMI remains matter of debate.
Methods
We used databases from two French multicentric and prospective registries: ACIRA (patients undergoing coronary angiography in any catheterization laboratories of Aquitaine) and REANIM (acute STEMI patients supported by emergency medical system (EMS) in Aquitaine). An ecological indicator of social deprivation Fdep09 was calculated to describe geographical inequalities in health based on municipality of residence. The higher the value, the more disadvantaged the population. Low SES was defined as Fdep09 > median value.
Results
Two-thousand-eight-hundred-and-forty consecutive patients with acute STEMI undergoing coronary angiography from January 2017 to December 2018 in Aquitaine were included. Patients with lower SES were more often initially referred to emergency departments of non-percutaneous coronary intervention capable centers whereas patients with higher SES were more often directly transferred to PCI centers by the mobile emergency care units as recommended by the most recent European guidelines (p<10–4). Patients with low SES had longer delays from symptom onset to first medical contact (FMC) (116 [60–119] vs 98 [55–233] min, p=0.0078) and were more likely to receive fibrinolysis (9.9 vs 5.2%, p<10–4). Linear regression modeling showed that each point of the Fdep09 index was associated with increase in the delay from symptom onset to FMC by a factor 1.1 (95% CI: 1.04–1.17, p<10–3) after adjusting for potential confounders.
Conclusion
SES inequality has negative influence on the delays in the management of acute STEMI patients. Efforts to raise awareness of suspicious signs of acute MI among individuals in lower SES could be valuable.
FDep09 distribution
Funding Acknowledgement
Type of funding source: Public Institution(s). Main funding source(s): ARS Nouvelle-Aquitaine
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Affiliation(s)
- L Cetran
- Hospital Haut Leveque, Cardiac Intensive Care Unit, Bordeaux, France
| | - E Lesaine
- University of Bordeaux, ISPED, Centre INSERM U1219, Bordeaux, France
| | - S Miganeh-Hadi
- University of Bordeaux, ISPED, Centre INSERM U1219, Bordeaux, France
| | - F Sevin
- University of Bordeaux, ISPED, Centre INSERM U1219, Bordeaux, France
| | | | - C Pradeau
- Pellegrin Hospital Group - University Hospital Centre, Bordeaux, France
| | - P Coste
- Hospital Haut Leveque, Cardiac Intensive Care Unit, Bordeaux, France
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Cetran L, Gerbaud E, Seguy B, Poustis P, Zirphile X, Coste P. Short-term coronary physiology parameters evolution in acute coronary syndrome patients with multivessel disease treated with ticagrelor. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2017.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Cetran L, Corneloup O, Dijos M, Montaudon M, Roudaut R, Coste P, Laurent F, Gerbaud E. [Caseous calcification of the mitral annulus, variable and revealing clinical picture, and the contribution of cardiac tomodensitometry to the diagnosis: report of two cases]. Ann Cardiol Angeiol (Paris) 2014; 63:114-118. [PMID: 23806861 DOI: 10.1016/j.ancard.2013.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Accepted: 03/13/2013] [Indexed: 06/02/2023]
Abstract
Caseous calcification of the mitral annulus (CCMA) is a rare variant of mitral annular calcification and a common echocardiographic finding. CCMA discovery is mostly incidental, considered as benign tumor and may be unrelated to patient symptoms. Multimodality imaging may have an additional value for the diagnosis of CCMA. We report the cases of two CCMA revealed by acute pulmonary oedema and stroke, respectively. The aims of this presentation are: to illustrate the variety of cardiac symptoms that led to the diagnosis of CCMA; and to highlight the usefulness of thoracic multisliced computed tomography for the diagnosis of CCMA.
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Affiliation(s)
- L Cetran
- Service de cardiologie et maladies vasculaires, hôpital cardiologique du Haut Lévêque, soins intensifs - plateau de cardiologie interventionnelle, CHU de Bordeaux, avenue de Magellan, 33604 Pessac cedex, France
| | - O Corneloup
- Unité d'imagerie thoracique et cardiovasculaire, hôpital cardiologique du Haut Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac cedex, France
| | - M Dijos
- Service de cardiologie et d'échocardiographie, hôpital cardiologique du Haut Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac cedex, France
| | - M Montaudon
- Unité d'imagerie thoracique et cardiovasculaire, hôpital cardiologique du Haut Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac cedex, France
| | - R Roudaut
- Service de cardiologie et d'échocardiographie, hôpital cardiologique du Haut Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac cedex, France
| | - P Coste
- Service de cardiologie et maladies vasculaires, hôpital cardiologique du Haut Lévêque, soins intensifs - plateau de cardiologie interventionnelle, CHU de Bordeaux, avenue de Magellan, 33604 Pessac cedex, France
| | - F Laurent
- Unité d'imagerie thoracique et cardiovasculaire, hôpital cardiologique du Haut Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac cedex, France
| | - E Gerbaud
- Service de cardiologie et maladies vasculaires, hôpital cardiologique du Haut Lévêque, soins intensifs - plateau de cardiologie interventionnelle, CHU de Bordeaux, avenue de Magellan, 33604 Pessac cedex, France.
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