Evolution of the interventional reperfusion strategy and reperfusion times in acute ST-segment elevation myocardial infarction

Abstract

In patients with acute ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI), the recommended times (first medical contact-to-balloon (M2B) < 120 min or < 90 min, and door-to-balloon (D2B) < 45 min) are reached in less than 50% of patients. To compare the interventional reperfusion strategy and reperfusion times between two series of consecutive STEMI patients referred for pPCI within 12 hours of symptom onset, in 2007 and 2012. Retrospective study of 182 patients, 87 admitted from January 2007 to March 2008 (period 1), and 95 admitted from January to December 2012 (period 2). The procedural characteristics and the different times between onset of pain and mechanical reperfusion were gathered and compared by non-parametric tests. Radial access, thrombo aspiration, and drug eluting stents were more frequent, and cardiogenic shock was less common during period 2, compared with the period 1. The median time from first medical contact and balloon (M2B) decreased by 26% (135 min, quartiles [113–183] in 2007 versus 100 [76–137] in 2012, P < 0.001), in relation to the reduction in both pre-hospital times and time in the catheterization laboratory (D2B 51 [44–65] and 44 min [37–55], respectively, P < 0.01). The D2B and M2B times significantly decreased in our centre between 2007 and 2012, and reached the recommended values in > 60% of the cases. This may be explained by better coordination between emergency medical units and interventional cardiologists, and by the presence of two paramedics in the cath lab for 24/24 7/7 pPCI since 2010 in France, in accordance with recent national regulation.