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Impact du mode d'arrivée aux urgences chez les patients avec un syndrome coronarien aigu avec élévation du segment ST (SCAST+) sur le devenir clinique en termes de FEVG et de survie

par Rousseaux, Chantal;Briki, Rachid ;De Marneffe, Michel ;Vandenbossche, Jean Luc ;Mols, Pierre ;Claessens, Benoît
Référence Revue médicale de Bruxelles, 30, 3, page (149-157)
Publication Publié, 2009-05

Article révisé par les pairs

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Résumé :

Emergency Medical Services (EMSs) play a key role in the recognition and treatment of ST-segment elevation myocardial infarction (STEMI). This study evaluates patient outcome according to his mode of arrival in the care unit dealing with acute coronary syndromes. Methods. Retrospective analysis of STEMI infarctions registered by the Belgian Interdisciplinary Working Group on Acute Cardiology (BIWAC) at Saint-Pierre University Hospital, Brussels (C.H.U. Saint-Pierre), between 01/01/2005 and 31/12/2006. Comparison of two groups according to their arrival in the care system : group 1 : brought in following an emergency call by mobile medical team (SMUR) or normal ambulance ; group 2 : arrived at the hospital by their own means and classic admission to Emergency Service. Studied parameters : descriptive patient characteristics, localisation of the infarction and survival to the end of hospitalization, to six months and to one year. Results. Among 136 patients, 56.6 % arrived by EMS and 43.4 % by their own means. Patients who arrived by EMS were older (p = 0.008) and had a higher Killip score (p < 0.05). Pain-to-Angiography and Door-to-Angiography intervals were shorter in patients who arrived by EMS (222 vs 416 mins, p < 0.0001 and 62.6 vs 147 mins, p < 0.0001, respectively). There were no differences in the left ventricular ejection fraction (LVEF) and survival. However, for patients suffering an IVA attack, survival to six months and one year was better in the EMS group (88.9 % vs 78.3 %, p < 0.05 and 80.5 % vs 69.6 %, p = 0.05). In conclusion, dealing with STEMI infarctions is quicker by EMS admission. The infarctions admitted by this way are more serious. Wherever STEMI infarctions were localised, no improvement of LV function and survival was observed according to the mode of arrival, contrary to the subgroup with an IVA attack where survival is better at six months and one year by EMS admission.