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Conflits d’intérêt Astra-Zeneca, BMS, MSD, Novartis, Pfizer, Daiichi-Sankyo, Servier,

Conflits d’intérêt Astra-Zeneca, BMS, MSD, Novartis, Pfizer, Daiichi-Sankyo, Servier, CRAM, AFSSAPS, ARH Région de Bourgogne Clos Vougeot. Nord. Essonne. Côte-d ’ Or. Haute-Savoie. Haute-Garonne. Demographic characteristics. 200 patients analysed. Côte-d ’ Or : 29

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Conflits d’intérêt Astra-Zeneca, BMS, MSD, Novartis, Pfizer, Daiichi-Sankyo, Servier,

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  1. Conflits d’intérêt Astra-Zeneca, BMS, MSD, Novartis, Pfizer, Daiichi-Sankyo, Servier, CRAM, AFSSAPS, ARH Région de Bourgogne Clos Vougeot

  2. Nord Essonne Côte-d’Or Haute-Savoie Haute-Garonne

  3. Demographic characteristics 200 patients analysed Côte-d’Or : 29 Haute-Garonne : 39 Nord : 57 Haute-Savoie : 37 Essonne : 38 Almost 3/4 of males : 72,5 % male

  4. Demographic characteristics – Meanage : 63,3 yrs with regional differences : 69,4 yrs in Côte-d’Or 60,0 yrs in Essonne – More thanhalf of patients retired(54 %), withregionaldifferences 74,1 % in Côte-d’Or 40,5 % in Essonne

  5. Risk factors and medical history – Hypertension : 43,5 % – Diabetes : 21,4 % – Active smoking : 44,9 % – Mean weight : 77 kg – BMI ≥ 30 : 20,8 % – CAD knownprior to admission : 19,7 %

  6. First aid – Chest pain reported in 93,9 % of cases – In 3/4 of cases (71,1 %), chest pain triggers a phone call –Emergency number 15 : only in 49 % of cases –Emergency ambulance (SAMU/SMUR)is the 1stmedical contactin lessthan 50 % of cases

  7. Revascularisation modes • Patients without reperfusion : older Half are female ¼ are employed

  8. 14 22 64 Thrombolysis Primary PCI No reperfusion France Widimsky P et al, Eur Heart J 2010; 31:943-57.

  9. Patients referred directly to an interventional cardiology unit 1er call P PCI Admission FMC symptom onset 33 min 43 min 20 min 54 min 97 min Preferred strategy is direct hospitalisation to cath-lab 64 %  as an average 70,2 % if patient referred by medical ambulance

  10. Patients referred to peripheral centres Admission to the cath lab P PCI FMC Symptom onset 163 min 227 min 204 min • Mean delay was more than double

  11. Effects of numbers of actors 9,7 % hospital mortality 5,5 4,2 Nr of actors

  12. French registriesof acute myocardial infarction

  13. Population USIC 2000 2320 patients 369 centres 1844 STEMI FAST-MI 2005 3059 patients 223 centres 1611 STEMI FAST-MI 2010 3069 patients 213 centres 1716 STEMI USIK 1995 2152 patients 373 centres 1536 STEMI

  14. FAST-MI 2010 213 centres Inclusion fromOctober 2010 4169 patients included 3079 patients includedduring the first month

  15. Proportion of STEMI patients from 1995 to 2010 Generalised use of troponin measurement

  16. Admission diagnosis: STEMI vs NSTEMI

  17. First place of arrival STEMI 38+11.5% call SAMU first 21% call their GP first 19% go to ER NSTEMI 29+8% call SAMU first 27% call their GP first 19% go to ER

  18. Evolution over 15 years

  19. Increased % of younger women

  20. Time to first call in STEMI patients % of patients calling ≤60 min from onset

  21. Use of the SAMU/firebrigade in STEMI Use of the SAMU/ FB in patients with STEMI 2005 2010

  22. Reperfusion therapy in STEMI

  23. STEMI: early mortality according to use and type of reperfusion therapy 2.6 2.1 - 48 % - 74 % - 70 %

  24. 30-day mortality: STEMI & NSTEMI 5 ?

  25. Other lessons learned from the French surveys

  26. Mortalityaccording to timing of PCI afterthrombolysisFAST-MI 2005 All patients with PCI after lysis Systematic pharmaco-invasive Rescue or symptom-driven PCI No PCI PCI ≤128 minutes PCI 129-220 minutes PCI > 220 minutes

  27. Geneticdeterminants of clopidogrel response and clinicalevents in FAST-MI 2005 FAST-MI registry 2,208 patients withAMI, followed for one year Number of CYP2C19 loss-of-function alleles Simon et al. NEJM 2009

  28. Early prescription of statinsisassociatedwithlowerrisk of developing acute AF % of patients developing AF Danchin et al. Heart 2010

  29. LMWH vs UFH in elderly patients Survival in propensity score-matched cohorts Puymirat et al. Int J Cardiol 2012

  30. Standard vs loading dose of clopidogrel in elderly patients: FAST-MI 2005 One-year event-free survival Adjusted HR (95%CI): 0.92 (0.68-1.25) Puymirat et al. Am J Cardiol 2011

  31. Conclusion Periodical surveys are a unique tool to document the evolution of management and outcomes in patients admitted with AMI. Both the organisation of care and acute management have considerably evolved in the past 15 years.

  32. Conclusion Early mortality has impressively decreased, both for STEMI and NSTEMI patients. The improved outcome in AMI patients is not related to one single therapeutic measure, but rather results from an improvement in the overall process of care. There are many lessons to be learned from such surveys.

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