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Master Thesis

Mieux comprendre les délais préhospitaliers avant angioplastie primaire pour les syndromes coronariens aigus avec sus-décalage du segment ST : étude observationnelle à partir du registre du RESURCOR

Abstract : Introduction: Primary angioplasty is recommended for STEMI (ST elevation myocardial infarction) reperfusion within 3 hours if it is accessible within 120 min. Otherwise, thrombolysis is indicated. These deadlines are frequently exceeded. The aim of our study is to determine what are the clinical and organizational factors, and which delays influence the overall delay for initial management. Method: The data come from the RESURCOR register and the SAMU medical files. The FMC(first medical contact)-puncture delay is analyzed with a limit of 100 minutes. Results: In univariate analysis, not extended inferior infarction 76 min [60-98], coronary history 72 min [64-90], individual homes 75 min [61-91], no PCI centers SMURs 85 min [74 -100] and transport firefighters 77min [63-94] significantly increase the FMC-puncture time. The median FMC-puncture time is 67 min [55-85], and exceeds the recommendations in 14.3% of cases. FMC-puncture is correlated with the delay FMC to departure from location 28 min [23-35], departure from location to hospital 16 min [9-27] and hospital to puncture 19 min [14-28]. A delay hospital-puncture of more than 20 minutes is associated with a significant risk of arriving out of time OR 34,7[4,5-264,2]. In multivariate analysis, the transport time estimated by a road application greater than 40 minutes OR 5.1 [1.7-15.3] and the female sex OR 3.5 [1.2-9.9] increase significantly the FMC-puncture delay. Conclusion: A hospital-puncture delay inferior or equal to 20 minutes is necessary to improve STEMI management. An estimated transport time superior or equal to 40 minutes must discuss the indication of thrombolysis.
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Master Thesis
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Submitted on : Monday, October 26, 2020 - 2:23:51 PM
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Florentin Guyomard, Briac Lemoine. Mieux comprendre les délais préhospitaliers avant angioplastie primaire pour les syndromes coronariens aigus avec sus-décalage du segment ST : étude observationnelle à partir du registre du RESURCOR. Médecine humaine et pathologie. 2020. ⟨dumas-02978432⟩

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