Nicolas DANCHINHEGP, Paris

Disclosures

Research grants: Astra-Zeneca, Eli-Lilly, Merck, Pfizer, sanofi-aventis, Servier, The MedCo

Fees for giving lectures and/or consulting:

Astra-Zeneca, BMS, Boehringer-Ingelheim, Brahms, Daiichi-Sankyo, Eli-Lilly, GSK, Menarini, MSD- Schering, Novartis, Novo, Pfizer, Pierre Fabre, sanofi-aventis, Servier, The MedCo

USIK1995

2152patients

1536with STEMI

French STEMI and NSTEMI registries: one-month nationwide surveys

USIC 2000

2320 patients

1670 with STEMI

FAST-MI2005

3059 patients

1611with STEMI

FAST-MI2010

3069 patients

1716with STEMI

French AMI registries: PCI use 1995 - 2010

Evolution of 30-day mortality in STEMI

2010 data are still provisional

5 ?

Twelve-month survival 1995 to 2005: STEMI population

P<0.001

89%86%81%

199520002005

Components of time delays to reperfusion

Patient-dependent component

Organisation of care

Reperfusion Rx and 30-d mortality according to # of parties involved before admission

FAST-MI 2005

Use of the SAMU in STEMI patients

FAST-MI 2005

Impact of pathway on reperfusion Rx

17% 17% 10% 15.5% 24% 13% of STEMI pts

FAST-MI 2005

Time from call to reperfusion according to pathway

Time to  IV lysis

Time to  primary PCI

SAMU to ER 60 (30; 85) 195 (121; 304)

SAMU to ICCU 57 (50; 68) 164 (115; 232)

SAMU to cath lab 58 (47; 66) 105 (85; 146)

GP to ER 115 (75; 170) 366 (240; 702)

Patient to ER 60 (48; 67) 167 (103;279)

Time from call to reperfusion includes time from first telephone call to MICU arrival

Reperfusion Rx and 4-year mortality according to the use of SAMU ambulances

Reperfusion Rx and 4-year mortality according to the place of admisson

FAST-MI 2005

Determinants of lack of reperfusion therapy

OR 95% CI

Age 1.02 1.02‐1.03

Time onset‐to‐call > 6 hours 2.01 1.29‐3.17

Hx of stroke 2.44 1.22‐4.89

Hx of CKD 2.27 1.07‐4.86

Typical chest pain 0.31 0.21‐0.43

Cardiac arrest 0.30 0.09‐0.95

LBBB on first ECG 9.72 4.63‐20.8

PCI capability at receiving institution 0.37 0.26‐0.52

First call to SAMU 0.53 0.39‐0.72

Admission to ICCU/cath lab vs ED 0.60 0.44‐0.81

Danchin et al. ESC 2009 FAST-MI 2005

Regional variations: First medical contact

3

4 28

LILLE

LYON

11

6

12.55

Nancy

Reims

Brest

Regional variations in pathways: % of patients with SAMU to cath lab

11.5 16

LILLE

LYON

19

14

1713

Nancy

Reims

Brest

Regional variations in pathways: % of patients coming directly to ER

20.5

5358,6

65,459,4 62,4

0

10

20

30

40

50

60

70

Ouest Nord-Nord Est Ile de France Centre Sud

p = 0.033%

Grandes régions

Regional variations

Percentage with reperfusion Rx

66,2 69,4 71,9 69 72,4

0102030405060708090

100

Ouest Nord-Nord Est Ile de France Centre Sud

p =NS%

Grandes régions

Percentage with reperfusion Rx in patients having called ≤3 hrs

Conclusion

Major role of the organization of care on:• 1) timely reperfusion Rx • 2) clinical outcomes

Regular "snapshot" surveys can identify weak spots in the organisation of care, and regional variations in patient management.

The methodology we used, however, cannot provide reliable data in individual centres (except the larger ones).