• Nicole Karam, Yves Lambert, Muriel Tafflet, Sophie Bataille, Hakim Benamer, Christophe Caussin, Philippe Garot, Sylvie Escolano, Françoise Boutot, Agnès Greffet, Jean-Yves Letarnec, Georges-Antoine Capitani, François Templier, Claude Lapandry, Arnold Auger, François Dupas, Stéphane Dubourdieu, Jean-Michel Juliard, Christian Spaulding, Xavier Jouven, and e-MUST Registry Investigators.
• Cardiology Department, Hôpital Européen Georges Pompidou (Assistance Publique-Hôpitaux de Paris), and Paris Descartes University, Paris, France; INSERM, U970, Paris Cardiovascular Research Center - PARCC, Paris, France.
• Int. J. Cardiol. 2013 Oct 15; 168 (6): 5149-55.

BackgroundESC guidelines recommend a shorter (90 min) delay for the use of primary percutaneous intervention (pPCI) in patients presenting within the first 2h of pain onset. Using registry data on STEMI patients in the Greater Paris Area, we assessed changes between 2003 and 2008 in the rates of pPCI, pre-hospital fibrinolytic therapy (PHF) and time delays in patients presenting within 2h of STEMI pain onset.MethodsThe Greater Paris Area was divided in 3 regions: Paris, the small and large rings. Patients were divided in three groups according to their reperfusion strategy: a) PHF, b) timely pPCI (FMC to balloon inflation time < 90 min), and c) late pPCI (FMC to balloon inflation time > 90 min).ResultsAmong the 5592 patients included, 1695 (39%) had PHF, 1266 (29%) had timely pPCI, and 1415 (32%) had late pPCI. Over the 6 years, there was a sharp increase in timely pPCI in all regions, balanced by a decrease in PHF. The rate of late pPCI remained globally stable, with a decrease in Paris, stabilization in the small ring, and an increase in the large ring, where the density of catheterization laboratories was the lowest. By multivariate analysis, using on-time pPCI as a reference group, mortality was higher in the PHF and late pPCI groups.ConclusionsIn areas with a low density of pPCI centers, efforts should be made to improve the timeliness of pPCI. Otherwise, PHF followed by an immediate transfer to a pPCI capable hospital may be considered.© 2013.

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