Abstract
The European HESCULAEP project’s objective is the evaluation of pre-hospital practice in Europe; HESCULAEP identified 2 regional ST-elevation myocardial infarction (STEMI) registries: e-MUST (Paris area, France, 11 million inhabitants) and PEFEX (Andalusia, Spain, 8 million inhabitants). The objective of this study is to compare these 2 registries, taking into account territorial, population and methodological differences. A comparison of common target population and common variables was performed. Population study was patients having a typical chest pain, lasting less than 24 hours in year 2006. In 2006, e-MUST included 1618 patients, versus 725 in PEFEX. Patients were more often men (77%) in both registries. They were younger in France (61 years old versus 63), p<10 −3 . Cardio-vascular risk factors were quite different: there were more often smokers and dylispemia in France, and more often High Blood Pressure and diabetes in Spain. Emergency teams arrived faster after onset of symptoms in Spain. Patients with Killip 1 were 90% in both registries. In e-MUST, 93% benefited from repermeabilisation decision by the ALS emergency team, versus 46% in PEFEX. Repermeabilisation consisted in thrombolysis in 27% in e-MUST versus 85% in PEFEX. This was performed earlier in France: 130 minutes after onset of chest pain, versus 155 minutes. Apart from Aspirin used in 93% of cases in both registries, adjuvant treatment was also quite different: antithrombotic and anticoagulant were less used in PEFEX than in e-MUST (respectively 17% versus 42% and 51% versus 91%). This was the opposite for nitrates and analgesics. In-hospital mortality was 6.6% in France versus 3.7% in Spain with no significant difference. Despite, regional, patients’ baseline characteristics and pre-hospital care differences in these 2 registries, in-hospital mortality was quite similar. At a further step, it is important to deeply analyze added-information and consequently improve patients’ management based on this pilot study.
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