007: Does a regional system of care impact on reperfusion strategies in ST-segment elevation myocardial infarction?

PurposeRegionalization of care for ST-segment elevation myocardial infarction (STEMI) has been advocated, although its effect on processes of care – compared with secular evolution – remains uncertain. The aim of this study was to evaluate the impact of a regional system of care on reperfusion strategies for STEMI patients relative to control hospitals.MethodsWe analysed the original data from two nationwide, prospective cohort studies, with the same methods. The fisrt was conducted in November 2000 (FAST MI 2010) and the second in November 2005 (FAST MI 2005). A total of 160 French hospitals participated in both studies. Seven hospitals (2 with percutaneous coronary intervention facilities and 5 without) were involved in a regional system of care implemented in the Northern Alps in 2002 (RESURCOR); 153 control hospitals were located in other French areas with no corresponding regional system of care. From 2002 to 2005, RESURCOR promoted prehospital fibrinolysis followed by routine/rescue coronary angiography. We compared change in rate of prehospital fibrinolysis and routine/rescue coronary angiography after fibrinolysis between 2000 and 2005 in the RESURCOR region versus the control hospitals.ResultsA total of 102 STEMI patients were enrolled in the Northern Alps hospitals and 2377 in the control hospitals. In the RESURCOR area we observed a larger absolute increase in the use of prehospital fibrinolysis (18% vs 63%, P<0.01, respectively, in 2000 and 2005) compared with the control hospitals (14% vs 31%, P<0.01, respectively, in 2000 and 2005). In the RESURCOR area we observed a larger absolute increase in the use of routine/rescue coronary angiography after fibrinolysis (9% vs 44%, P<0.01, respectively, in 2000 and 2005) when compared with control hospitals (7% vs 22%, P