252 Assessment of emergency care of patients with ST+ Acute Coronary Syndromes

Abstract

Objectives and BackgroundThe objective was to evaluate the emergency care of patients presenting with ST+ACS in the context of the recommendations of the French Societies of Emergency Medicine and Cardiology with a view to reducing ACS morbi-mortality: the use of the SAMU call center; antiplatelet treatment; admission in cardiology intensive care unit (CICU), reperfusion therapy rate>75%; delay from first medical contact to electrocardiogram (ECG) interpretation <10 min; to angioplasty (door to balloon) <90 min; to thrombolysis (door to needle) <30 min.ProgramA multicentre, longitudinal, multidisciplinary register covering the Department. Every patient seen by an emergency physician for an ST+ACS within 12 h either by prehospital, by a mobile intensive care unit (MICU) or presenting themselves at the public and private emergency rooms (ER) was included and followed for one month. The data regarding treatments and delays and in hospital mortality were recorded in prehospital, in ER or after transfer to CICU. The Haute Autorité de Santé clinical practice indicators were used and descriptive statistical analyses carried out with the delays expressed as medians (interquartile). The main measures were compared between the patients arriving via the MICU and those presenting ER, using the chi-square (qualitative variables) and the Mann–Whitney test (quantitative variables).ResultsBetween January 2007 and June 2008, 417 patients were included (mean age 62; sex ratio 3.1), with 80% by the MICU after calling the SAMU. The completion rate was 96%. The time between the onset of pain and first medical contact was 97 min (54–180), that is, <3 h for 75% of the patients. An ECG was done in 7 min (5–13). The rate of admission to the CICU was 98% with a delay of 89 min (60–136), with 9% being under 45 min. The antiplatelet therapy (aspirin and clopidogrel) rate was 85%. The rate of reperfusion was 96%, of which 65% by primary angioplasty and 32% by thrombolytic therapy. The median door to balloon delay was 136 min (97–208) and door to needle delay 20 min (10–24). The in-hospital mortality rate was 4.3%.MICU and ER comparison: reperfusion rate was ≥95%, with no significant difference reported (respectively, 95.5% vs 97.5%, p=0.39). MICU patients had significantly shorter treatment delays: door to balloon (122 min vs 196, p=0.0001), door to needle (20 min vs 28, p=0.001), door to ECG (6 min vs 11, p=0.001). Antiplatelet agents prescription was high, with no reported significant difference (85% vs 86%, p=0.94).DiscussionThe register enables to objectively compare the emergency systems using the relevant medical indicators. The results are in agreement with the standard recommendations, with the exception of the time of door to balloon, which should be improved. The longer waiting times seen for the independent arrivals in Emergency confirms, in the case of chest pain, the necessity of a recourse to the SAMU call centre number 15 in the first instance.ConclusionThe register enables the emergency care routes to be evaluated and confirms...