共查询到9条相似文献,搜索用时 0 毫秒
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Purpose of the study
Estimating the quality of care of the patients presenting an ST-elevation myocardial infarction in Vendee.Patients and method
Prospective observational study carried out over the year 2008. Included patients presenting a myocardial infarction for less than 24 hours, they were alive when emergency team arrived, and were taken care of by the SMUR, the emergencies or the cardiology of the hospital of La Roche-sur-Yon.Results
Two hundred and seventeen patients were included, 163 men and 54 women, average age: 65 years. Fifty-six percent of the patients called initially the emergency medical service, half of those within an hour after pain began. Seventy-two percent of them were looked after by a SMUR. Twenty-six percent consulted initially a general practitionner, and one third of those were redirected towards the emergency medical service. Thirty percent of all patients followed the ideal procedure defined by succession of chest pain, emergency medical service call, SMUR, angioplasty or fibrinolysis. The average time between the ECG and the fibrinolysis is 36 minutes, or of the arrival in coronarography room is 105 minutes. The balloon is inflated 42 minutes later. Eighty-six percent of the patients taken care of in the acute phase benefited from a strategy of reperfusion, primary angioplasty (63%) or fibrinolysis (21%). Ninety percent of revascularisations were successful.Conclusion
In the case of the chest pain, the emergency medical service is under-used. The number of revascularised patients is satisfactory, but the whole procedure takes too much time, especially when the treatment is the angioplasty. 相似文献3.
H. Benamer P. Motreff P. Jessen M. Piquet F. Haziza B. Chevalier 《Annales de cardiologie et d'angeiologie》2015,64(6):460-466
The outcome of patients with ST elevation acute coronary syndrome (ACS) has been increasingly improving in the general population over the past few decades. However, detailed analysis of the results show that the reduction in mortality rates is higher in males compared to their female counterparts. The excess mortality rate observed in women, though sometimes questioned, has been widely reported in the literature. The higher mortality rate observed in women with ST elevation ACS can be explained by the presence of aggravating clinical factors such as older age, a higher percentage of diabetics, and a higher frequency of cardiogenic shock. Other factors pertaining to patient management seem to negatively impact the outcome. These factors include a lower use of reperfusion strategies, longer time to treatment mainly as a result of diagnostic uncertainty with respect to a disease, which is believed to affect principally the male gender. The doubts that female patients themselves and their families have about the nature of their symptoms are also present in the medical environment but cease to exist in the catheterization laboratory. This is illustrated in the first clinical case that we present here. Coronary reperfusion is the cornerstone of the therapeutic management of MI. In this context, bleeding complications associated with the implemented treatments can also result in an increased mortality rate in this more vulnerable population. When all the factors likely to influence the prognosis are taken into account, excess mortality seems to persist in women, especially in younger patients. As described in the second clinical case, a distinct physio-pathological factor, more frequent in women, could account for this higher mortality rate. Indeed, spontaneous coronary dissection and intramural hematoma are not always easy to diagnose and may not be adequately managed by reperfusion treatments. In addition, these coronary reperfusion strategies are probably not adapted to this type of ACS. It is, therefore, very important to identify them by angiography coupled with intra-coronary imaging examination when necessary and to carry out further research to adjust our PCI techniques to this pathology. 相似文献
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The European Society of Cardiology (ESC) and American College of Cardiology/American Heart Association (ACC/AHA) have recently updated guidelines for management of ST-elevation myocardial infarction (STEMI). The aim of this study is to compare the both recommendations. 相似文献
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Introduction
Managing patients with non-ST elevation myocardial infarction (NSTEMI) require their transfer to an interventional cardiology center. The inter-hospital transfer (IHT) of these patients is managed by the Emergency Medical Service (EMS) which often requests a medicalised transport of such patients due to the risk of complications.Aim of the study
Evaluating the incidence of cardiovascular complications that require medical intervention, occurring during IHT of patients with uncomplicated NSTEMI.Methods
We conducted a retrospective study for one year (August 2010–July 2011) in the SAMU-85 unit using the regulation software Centaure®. All patients with NSTEMI who had been transferred from one of the peripheral hospitals in the region of Vendee were included.Results
The study population group is composed of one hundred and fifty-nine patients. No cardiovascular complications requiring medical intervention occurred during the transport. Seventeen patients (10.7%) had cardiovascular complications: repolarization disorder (7), chest pain (3), dyspnea (3), arrhythmia (2), and bradycardia (2). These complications did not require action or medical intervention.Conclusion
The medicalization of IHT of patients with NSTEMI who do not show complications before transfer, is probably questionable. Indeed, according to this study made on 159 patients, no cardiovascular event requiring medical intervention was reported during transport. 相似文献6.
Acute coronary syndrome results in most cases of atherosclerotic plaque rupture. In a few cases, the physiopathological mechanism is different. This does not necessarily change the initial strategy but the subsequent treatments. We report three cases of clinical presentations of acute coronary syndrome whose pathophysiological mechanism is not or not mainly due to atherosclerotic lesions. Based on these cases and a review of the literature, two topics will be tackled: the diagnostic and therapeutic strategy in the management of Tako-tsubo cardiomyopathies and also acute coronary syndromes due to vasospastic angina. 相似文献
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