Decision to deploy coronary reperfusion is not affected by volume of STEMI patients managed by prehospital emergency medical teams

Lapostolle Frédéric, Aurélie Loyeau, Yasmine Beggaz, Thevy Boche, Virgine Pires, Gaëlle Le Bail, Lionel Lamhaut, Benoît Simon, François Dupas, Alexandre Allonneau, Jean-Michel Juliard, Hakim Benamer, Sarah Tepper, Sophie Bataille, Yves Lambert

Resumen


Introduction

In case of chest pain, alert time, 'pain to call' delay is a major determinant of prognosis. Identifying conditions associated with an extension of this delay is therefore crucial.

Objective

To analyze changes in alert time according to the time of the day, age and gender.

Methods

Data from a regional, prospective registry that included all <24 hours STEMI patients managed in pre-hospital setting by 39 MICU in the Great-Paris area. We analyzed the variation of the alert time according to the time of onset of pain, age and gender. Impact on the myocardial reperfusion decision was recorded.

Results

24,662 patients included, 19,291 (78%) men and 4,371 (22%) women; median age 61 (52-73) years; 59 (51-69) years for men and 73 (59-83) years for women (p<0.0001). Median alert time was 60 (24-164) minutes. It was 55 (23-150) minutes for men and 79 (31-220) minutes for women (p<0.0001). It was longer in women regardless of the time of pain onset. It increased significantly with age for both men and women (p<0.0001). It was minimum in men between 17:00 and 18:00 and maximum for women between 02:00 and 03:00, respectively 40 (17-101) and 149 (43-377) minutes. The lengthening of the alert period was associated with a significant reduction in the rate of coronary reperfusion decisions (p<0.0001).

Conclusion

The alert time was prolonged, especially during the night, in women and older patients. Age and gender disparities make it possible to define preferred targets for education.


Palabras Clave


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