Acute myocardial infarction with ST segment elevation (STEMI): distribution of delays between first medical contact to primary percutaneous coronary intervention

Abstract

Purpose: The European Society of Cardiology recently issued recommendations on First Medical Contact to primary Percutaneous Coronary Intervention (balloon inflation) delays (FMC-pPCI) depending on the time of onset of STEMI symptoms. This study aimed to assess if recommended FMC-pPCI delays are respected in a large French city for patients presenting an uncomplicated STEMI of less than 2 hours treated with a primary PCI. Methods: We analyzed data from the prospective registry e-MUST that includes all STEMI managed by eight pre-hospital emergency medical units (SMUR) covering a large region in France. In all patients with uncomplicated STEMI of less than 2 hours, we evaluated patients' characteristics, FMC-pPCI delay, characteristics of STEMI onset, and hospital mortality. The results are presented as median (25th-75th percentiles) or numbers (%). Results: Between 2003 and 2010, 717 patients were included (table 1). A FMC-pPCI > 120 min was more frequent in women, elderly patients, and during days off. Hospital mortality increased progressively with increase in FMC-pPCI delays. View this table: Table 1. Uncomplicated STEMI ≤2h with pPCI in a large French city (2003–2010) Conclusions: The FMC-pPCI delays recommended by the ESC are not always respected. It is important to shorten these delays by acting on modifiable factors. Pre-hospital thrombolysis should be considered as an alternative reperfusion strategy the expected FMC-pPCI delay is too long.