[Reperfusion in ST elevation myocardial infarction. From the guidelines to practice].

Area of Science:

• Cardiology
• Emergency Medicine
• Health Services Research

Background:

• International guidelines recommend reperfusion strategies (fibrinolysis or angioplasty) for ST-segment elevation myocardial infarction (STEMI).
• Emergency-care networks are advised to adapt these guidelines to local contexts.
• Adherence to these adapted guidelines in real-world settings requires evaluation.

Purpose of the Study:

• To evaluate the proportion of STEMI patients treated with fibrinolysis or angioplasty according to regional guidelines.
• To identify factors associated with adherence to reperfusion guidelines in a French emergency network.

Main Methods:

• An observational study utilizing a permanent registry of STEMI patients (duration <12h) in the French North Alps (2009-2012).
• Data collected on reperfusion type (fibrinolysis vs. angioplasty) and adherence to regional guidelines.
• Multivariable analysis to identify predictors of guideline-recommended reperfusion.

Main Results:

• Out of 2620 STEMI patients, 93% received reperfusion, with 60% treated in accordance with guidelines.
• Guideline-recommended fibrinolysis was used in 47% and angioplasty in 79% of eligible patients.
• Younger age (<65), management in Haute-Savoie, lower blood pressure, and initial treatment by mobile intensive care units were associated with higher adherence.

Conclusions:

• A significant proportion (40%) of STEMI patients did not receive reperfusion therapy aligned with regional guidelines.
• Understanding the characteristics of non-adherent patients is key to improving future guideline implementation.
• Further efforts are needed to enhance adherence to STEMI reperfusion protocols within emergency networks.