L. Orion

Acute Myocardial Infarction: Changes in Patient Characteristics, Management, and 6-Month Outcomes Over a Period of 20 Years in the FAST-MI Program (French Registry of Acute ST-Elevation or Non-ST-elevation Myocardial Infarction) 1995 to 2015

Background: ST-segment–elevation myocardial infarction (STEMI) and non–ST-segment–elevation myocardial infarction (NSTEMI) management has evolved considerably over the past 2 decades. Little information on mortality trends in the most recent years is available. We assessed trends in characteristics, treatments, and outcomes for acute myocardial infarction in France between 1995 and 2015. Methods: We used data from 5 one-month registries, conducted 5 years apart, from 1995 to 2015, including 14 423 patients with acute myocardial infarction (59% STEMI) admitted to cardiac intensive care units in metropolitan France. Results: From 1995 to 2015, mean age decreased from 66±14 to 63±14 years in patients with STEMI; it remained stable (68±14 years) in patients with NSTEMI, whereas diabetes mellitus, obesity, and hypertension increased. At the acute stage, intended primary percutaneous coronary intervention increased from 12% (1995) to 76% (2015) in patients with STEMI. In patients with NSTEMI, percutaneous coronary intervention ⩽72 hours from admission increased from 9% (1995) to 60% (2015). Six-month mortality consistently decreased in patients with STEMI from 17.2% in 1995 to 6.9% in 2010 and 5.3% in 2015; it decreased from 17.2% to 6.9% in 2010 and 6.3% in 2015 in patients with NSTEMI. Mortality still decreased after 2010 in patients with STEMI without reperfusion therapy, whereas no further mortality gain was found in patients with STEMI with reperfusion therapy or in patients with NSTEMI, whether or not they were treated with percutaneous coronary intervention. Conclusions: Over the past 20 years, 6-month mortality after acute myocardial infarction has decreased considerably for patients with STEMI and NSTEMI. Mortality figures continued to decline in patients with STEMI until 2015, whereas mortality in patients with NSTEMI appears stable since 2010.

Infarctus du myocarde par embolie coronaire : pas si rare que cela ? Revue de la littérature à propos de cinq observations de patients en arythmie complète par fibrillation auriculaire

Five cases of myocardial infarction suspected to be due to coronary embolism are presented. All five patients had atrial fibrillation (AF), four of them with nonvalvular AF. The literature regarding coronary embolism is reviewed; the clinical manifestations and the place of AF are discussed.

Indications for fibrinolysis in patients with ST-segment elevation myocardial infarction: From guidelines to practice

BACKGROUND European guidelines on managing ST segment elevation myocardial infarction (STEMI) during the first 12hours recommend fibrinolysis when the time elapsing between the first medical contact and balloon time (FMCBT) is more than 120minutes. AIM To assess the real-life clinical efficacy of guidelines on fibrinolysis in managing STEMI and identify obstacles to their everyday implementation. METHODS An observational study based on a permanent registry of reperfusion strategies and timing among patients treated in a French general hospital for STEMI with chest pain lasting for less than two hours. Patients were enrolled between January 1st 2008 and December 31st 2014. RESULTS The study included 669 patients: 79 (11.8%) benefited from effective fibrinolysis followed by coronary arteriography (PCI) within 24hours, 445 (66.5%) underwent a primary PCI, 99 (14.8%) received a rescue PCI and 46 (6.9%) did not undergo revascularization. The FMCBT was 120minutes or longer in 209 patients: fibrinolysis was performed in 68 of these patients (32.5%), and primary PCI in 141 (114 (54.6%) without contraindications to fibrinolysis and 27 (12.9%) with contraindications). The patients age, female gender, co-morbidities and clinical management were factors that appeared to be linked to poor compliance with the guidelines, but none were significant (P>00.5). Nor were there significant differences regarding bleeding complications between patients receiving fibrinolysis or primary PCI (P>0.05). CONCLUSION The guidelines on fibrinolysis were not followed in 54.6% of patients when the FMCBT was more than 120minutes. Some criteria (age, gender, co-morbidities) may have been responsible for this non-compliance, although underestimating the time between first medical contact and arrival in the catheterisation laboratory could not be excluded. Further studies are necessary to improve estimates of this delay.