• José Labarère, Loic Belle, Magali Fourny, Gérald Vanzetto, Guillaume Debaty, David Delgado, Julien Brallet, Benoît Vallet, Nicolas Danchin, USIC 2000, and FAST-MI.
• Quality of Care Unit, Grenoble University Hospital, Grenoble, France. jlabarere@chu-grenoble.fr
• Arch Cardiovasc Dis. 2012 Aug 1; 105 (8-9): 414-23.

BackgroundRegionalization of care for ST-segment elevation myocardial infarction (STEMI) has been advocated, although its effect on processes of care and clinical outcomes remains uncertain.AimTo assess the impact of a regional system of care on provision of reperfusion therapy for STEMI patients relative to control hospitals.MethodsWe analysed the original data from two nationwide prospective cohort studies conducted in 2000 and 2005, respectively. Overall, 160 hospitals participated in both studies, including seven hospitals involved in a regional system of care implemented in the Northern Alps in 2002 and 153 control hospitals located in other French areas.ResultsA total of 102 and 2377 STEMI patients were enrolled in Northern Alps and control hospitals, respectively. Overall, patients enrolled in 2005 were more likely to receive any reperfusion therapy (60% vs 52%; P < 0.001), prehospital fibrinolysis (33% vs 15%; P < 0.001), and primary percutaneous coronary intervention (32% vs 26%; P < 0.001) than those enrolled in 2000. However, the regional system of care was associated with a larger absolute change in the use of prehospital fibrinolysis (45.0 vs 17.0; P = 0.02) and rescue or early routine coronary angiography or intervention after fibrinolysis (35.3 vs 15.2; P = 0.01). Patients enrolled in 2005 had lower adjusted hazard ratios for death (0.70, 95% confidence interval 0.57-0.87; P = 0.001), with no significant interaction between study groups.ConclusionRegionalization of care for STEMI patients improves access to reperfusion therapy, although its impact on clinical outcomes deserves further study.Copyright © 2012 Elsevier Masson SAS. All rights reserved.

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