Conflits d’intérêt
Astra-Zeneca, BMS, MSD, Novartis,
Pfizer, Daiichi-Sankyo, Servier,
CRAM, AFSSAPS, ARH
Région de Bourgogne
Clos Vougeot
Agrément FMC N° 100 437
Popul.
millions
Area
km2
Density
inha/km2
NORD
2,5
5 743
447
Essonne
1,2
1 804
668
Hte
Garonne
1,2
6 309
193
Hte
Savoie
0,7
4 388
163
Côte
d’Or
0,5
8 763
60
Nord
Essonne
Côte-d’Or
Haute-Savoie
Haute-Garonne
#6
Demographic characteristics
200 patients analysed
Côte-d’Or :
29
Haute-Garonne : 39
Nord :
57
Haute-Savoie : 37
Essonne :
38
Almost 3/4 of males : 72,5 % male
Demographic characteristics
– Mean age : 63,3 yrs with regional differences :
69,4 yrs in Côte-d’Or
60,0 yrs in Essonne
– More than half of patients retired (54 %), with regional
differences
74,1 % in Côte-d’Or
40,5 % in Essonne
–
–
–
–
–
Risk factors and medical history
Hypertension : 43,5 %
Diabetes :
21,4 %
Active smoking : 44,9 %
Mean weight :
77 kg
BMI ≥ 30 :
20,8 %
– CAD known prior to admission : 19,7 %
First aid
– Chest pain reported in 93,9 % of cases
– In 3/4 of cases (71,1 %), chest pain triggers a phone call
– Emergency number 15 : only in 49 % of cases
– Emergency ambulance (SAMU/SMUR) is the 1st medical
contact in less than 50 % of cases
Revascularisation modes
Population
Age
Female (%)
Occupation (%)
Employed
Unemployed
Retired
Fibrinolysis
Primary PCI
no reperfusion
p
22 %
64 %
14 %
< 0,001
63 ± 13
23 %
62 ± 13
24 %
70 ± 12
50 %
< 0,01
< 0,02
44
5,1
51,3
41
8,1
50,5
22
4,3
73,9
• Patients without reperfusion :
older
Half are female
¼ are employed
0,32
14
22
Primary PCI
Thrombolysis
No reperfusion64
France
Widimsky P et al, Eur Heart J 2010; 31:943-57.
Patients referred directly to an interventional cardiology unit
sympto
m onset
1er call
33 min
FMC
20 min
Admission
54 min
P PCI
43 min
97 min
Preferred strategy is direct hospitalisation to cath-lab
64 % as an average
70,2 % if patient referred by medical ambulance
Patients referred to peripheral centres
Symptom
onset
Admission to
the cath lab
FMC
163 min
204 min
• Mean delay was more than double
227 min
P PCI
% hospital mortality
12
Effects of numbers of actors
9,7
8
4
4,2
5,5
0
≤'1
2
3+
Nr of actors
French registries
of acute myocardial infarction
Population
USIK
1995
USIC
2000
FAST-MI
2005
FAST-MI
2010
2152
patients
373 centres
2320
patients
369 centres
3059
patients
223 centres
3069
patients
213 centres
1536 STEMI
1844 STEMI
1611 STEMI 1716 STEMI
FAST-MI 2010
 213 centres
 Inclusion from October
2010
 4169 patients included
 3079 patients included
during the first month
Proportion of STEMI patients from 1995 to 2010
Generalised use
of troponin
measurement
Admission diagnosis:
STEMI vs NSTEMI
First place of arrival
STEMI
38+11.5% call SAMU first
21% call their GP first
19% go to ER
NSTEMI
29+8% call SAMU first
27% call their GP first
19% go to ER
Evolution over 15 years
Increased % of younger women
Time to first call in STEMI patients
Median
25th; 75th
percentiles
2000
138
2005
90
2010
74
60; 480
30; 287
30; 240
% of patients calling ≤60 min from onset
Use of the SAMU/firebrigade in STEMI
Use of the SAMU/ FB in patients with STEMI
2005
2010
Reperfusion therapy in STEMI
STEMI: early mortality according to use and
type of reperfusion therapy
2.6
2.1
- 48 %
- 74 %
- 70 %
30-day mortality: STEMI & NSTEMI
5?
Other lessons learned from
the French surveys
Mortality according to timing of PCI after thrombolysis
FAST-MI 2005
All patients with PCI after lysis
Systematic pharmaco-invasive
Rescue or symptom-driven PCI
No PCI
PCI ≤128 minutes
PCI 129-220 minutes PCI > 220 minutes
Genetic determinants of clopidogrel response and
clinical events in FAST-MI 2005
FAST-MI registry
2,208 patients with
AMI, followed for
one year
Simon et al. NEJM 2009
Number of CYP2C19 loss-of-function alleles
Early prescription of statins is associated
with lower risk of developing acute AF
% of patients developing AF
Danchin et al. Heart 2010
LMWH vs UFH in elderly patients
Survival in propensity score-matched cohorts
Adjusted OR [95%
CI]
Major bleeding
Any blood
Puymirat et al. Int J Cardiol 2012
transfusion
0.41 [0.20-0.83]
0.49 [0.28-0.85]
Standard vs loading dose of clopidogrel in
elderly patients: FAST-MI 2005
One-year event-free survival
Adjusted HR (95%CI): 0.92 (0.68-1.25)
Adjusted OR [95%
CI]
In-hospital death
0.91 [0.50-1.68]
Bleeding or
Puymirat et al. transfusion
Am J Cardiol 2011
1.03 [0.49-2.17]
Conclusion
 Periodical surveys are a unique tool to
document the evolution of management
and outcomes in patients admitted with
AMI.
 Both the organisation of care and acute
management have considerably
evolved in the past 15 years.
Conclusion
 Early mortality has impressively decreased,
both for STEMI and NSTEMI patients.
 The improved outcome in AMI patients is not
related to one single therapeutic measure,
but rather results from an improvement in the
overall process of care.
 There are many lessons to be learned from
such surveys.