Évolution dans le temps et déterminants de l’entrée dans la filière de prise en charge « idéale » de l’infarctus aigu du myocarde. Étude EFIM

International audienceIntroductionAcute myocardial infarction outcome is strongly related to time of reperfusion. Since 2006, an early call to the SAMU is recommended. However, many patients escape this “ideal” way.ObjectiveTo study the evolution and determinants of entry into the “ideal” chain of care.MethodsAnalysis of the data of a prospective register of 8 SAMUs and 39 Mobiles Intensive Care Units in Île-de-France. Inclusion: patient with ST-elevated myocardial infarction with (STEMI) of less than 24 hours managed in prehospital settings. Criteria: age, gender, call by general practitioners (GP), management time, coronary reperfusion decision. Analysis by district characterized by: position vs. Paris, overall population, population over 75 years, median income, number of physicians and GP per inhabitant.ResultsIn all, 21,821 patients included from 2003 to 2015, 16,980 (78 %) men, 4783 (22 %) women, mean age 62 ± 14 years. MG's call decreased from 20 % (2003) to 8 % (2015) (P < 0.0001 Cochran-Armitage). Management time was significantly shorter: 76 vs. 173 min in case of a direct call to the SAMU (P < 0.0001 Wilcoxon). The MG call increased significantly with the rate of doctors (R2 = 0.5; P = 0.04) and GP (R2 = 0.6; P = 0.03) per million inhabitants, but was independent of other criteria.ConclusionThe direct call to the SAMU reduced the time of care of STEMI patients. Initial GP contact must be further reduced to favor access to the “lucky way”