[Retrospective survey of the management of patients treated for acute myocardial infarction in Provence-Alpes-Côte d'Azur].
ABSTRACT The aim of the study is to assess the characteristics, outcomes and factors associated with delay of reperfusion therapy in patients with myocardial infarction in the Provence Alpes Côte d'Azur (PACA).
This retrospective study included all patients hospitalized with myocardial infarction in the PACA between January and June 2000. Myocardial infarction patients were identified using the Programme de Médicalisation des Systèmes d'Information. Univariate and multivariate analysis were performed.
A total of 2049 patients were admitted in 74 hospitals. Mean patient age was 68.9. Treatment consisted of coronary angioplasty alone in 53.3% of cases, thrombolysis alone in 4.5% and angioplasty after thrombolysis in 7.7%. The complication rate was 27.4% and mortality was 9.5%. The median time from first awareness of symptoms to the first action taken by the patient (1) was 1 hour 30 minutes. The time from the first action taken by the patient to revascularisation (2) was 3 hours 30 minutes. The time between the first awareness and revascularisation (3) was 8 hours 45 minutes. Multivariate analysis showed that the following factors were associated with increased delay: (1). no prior myocardial infarction, occurrence of symptoms at home. (2). age > 65 years, absence of chest pain, consultation with a physician before hospitalization, non-medical transport, transfer from one hospital to another, treatment by angioplasty alone. (3). age > 65 years, absence of chest pain, consultation with a physician before hospitalization, non-medical transport, treatment by angioplasty alone.
Alerting emergency services more quickly would shorten treatment delay not only by ensuring quicker transport to a properly equipped hospital but also by allowing prompt pre-hospital thrombolytic therapy.