Évaluation départementale des délais de reperfusion des syndromes coronariens aigus avec élévation du segment ST en fonction de la filière de recours aux soins

Introduction

Acute coronary syndrome with ST segment elevation (STEMI) remains a major cause of morbidity and mortality in France, directly correlated with the time management of the patient to achieve reperfusion of the artery as early as possible. But the delay of reperfusion is related to the course that will take the patient to the revascularization.

Methods

To make an observation of departmental practices, we conducted a retrospective monocentric study on the STEMI supported on 4 years in the Departmental Hospital of La Roche-sur-Yon by comparing the time of reperfusion in two groups: patients who used the recommended chain = diRect chain (Call the emergency number–specialist mobile emergency unit–Cardiac intensive care unit or cardiac catheterization laboratory), and patients who used another chain = Long chain.

Results

On 838 patients with STEMI, 356 (42.5%) used the Direct chain. The average time of reperfusion in the Direct chain group is 4.26 hours (±3.12), 6.17 hours (±4.82) in the Long chain group. There is a significant difference between the two groups of 1.9 hours (P < 0.001). Of 186 patients who consulted a general practitioner, 40.3% of patients were not supported by the mobile emergency unit.

Conclusion

These results should lead to improved practices, to carry on continuing medical education with all actors in the chain and patient information to shorten up the time of reperfusion.