• Abbas Sandouk, Jean-Louis Ducassé, Sabrina Grolleau, Olivier Azéma, Meyer Elbaz, Bruno Farah, Amir Tidjane, Michelle Kelly-Irving, and Sandrine Charpentier.
• Regional Observatory of Emergency Medicine in Midi-Pyrénées, Purpan University Hospital, Toulouse, France.
• Arch Cardiovasc Dis. 2012 May 1;105(5):262-70.

BackgroundGuidelines emphasize the implementation of local networks with prehospital emergency medical systems to improve the management of patients with ST-segment elevation myocardial infarction (STEMI); they also define the choice of reperfusion strategies and adjunctive treatments.AimTo assess the compliance of STEMI emergency care with current French guidelines in a large area of France and to identify predictors of compliance with guidelines.MethodThe RESCA+31 registry was a 2-year, multicentre, prospective, multidisciplinary study, including 512 consecutive patients with STEMI evolving within 12 hours managed by emergency physicians in the prehospital system or emergency department. Data were recorded during the emergency phase and after admission to cardiology.ResultsFirst medical contact (FMC) was prehospital emergency care for 80% of patients; 97% received reperfusion treatment and 98% were admitted to a cardiology intensive care unit (CICU) with a catheterization laboratory. The mortality rate was 5%. Guidelines were complied with in 41% of patients for reperfusion strategies, in 47% for adjunctive treatments and in 23% for both. The only factor independently associated with guideline compliance was FMC by prehospital emergency system. In 52% of cases, emergency physicians underestimated the delay between FMC and admission to a CICU.ConclusionDespite the implementation of a network, compliance with guidelines for reperfusion strategies and adjunctive treatments was insufficient in our area. However, very few patients did not receive reperfusion therapy and the mortality rate was low. Efforts should be made to improve the estimation of delay before primary percutaneous coronary intervention.Copyright © 2012 Elsevier Masson SAS. All rights reserved.

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