[Analysis of cardiovascular complications occurring during inter-hospital transfers of patients with non-ST elevation myocardial infarction]. / Étude des complications per-transfert interhospitalier des patients présentant un syndrome coronarien aigu sans élévation du segment ST.

AIM OF THE STUDY: Patients with non ST-segment elevated acute coronary syndrome justify specific management in a hospital with an Intensive Cardiac Care Unit. In our area, these transfers are often provided by the Emergency Medical Service. Nevertheless we wonder whether a quasi-systematic medicalization of these patients is rational. PATIENTS AND METHOD: We tried to authenticate the need for medicalization of these patients through a prospective study including any patient with acute non-ST elevation Coronary Syndrome managed in one of the peripheral hospitals of the area and transferred to the major hospital center in La Roche-sur-Yon. We noted all the complications that occurred during the transfer and, if need be, when these complications required medical intervention. RESULTS: Out of 226 patients included, 19 had a complicated form of acute non-ST elevation Coronary Syndrome. Out of the remaining 207 patients, 16 (7.7 %) showed a complication during their transfer, 5 of which underwent a medical intervention, none of which was immediately vital. Nevertheless, the statistical analysis did not highlight any significant worsening factors. CONCLUSION: The low rate of complications occurring during the transfer of initially stable patients encourages us to limit our indications of medicalization in favour of only the unstable patients or having a complication of their non-ST elevation acute coronary syndrome.

[Reperfusion delays in acute coronary syndromes with ST segment elevation (STEMI) depending on prehospital care]. / Évaluation départementale des délais de reperfusion des syndromes coronariens aigus avec élévation du segment ST en fonction de la filière de recours aux soins.

INTRODUCTION: Acute coronary syndrome with ST segment elevation (STEMI) remains a major cause of morbidity and mortality in France, directly correlated with the time management of the patient to achieve reperfusion of the artery as early as possible. But the delay of reperfusion is related to the course that will take the patient to the revascularization. METHODS: To make an observation of departmental practices, we conducted a retrospective monocentric study on the STEMI supported on 4years in the Departmental Hospital of La Roche-sur-Yon by comparing the time of reperfusion in two groups: patients who used the recommended chain=diRect chain (Call the emergency number-specialist mobile emergency unit-Cardiac intensive care unit or cardiac catheterization laboratory), and patients who used another chain=Long chain. RESULTS: On 838 patients with STEMI, 356 (42.5%) used the Direct chain. The average time of reperfusion in the Direct chain group is 4.26hours (±3.12), 6.17hours (±4.82) in the Long chain group. There is a significant difference between the two groups of 1.9hours (P<0.001). Of 186 patients who consulted a general practitioner, 40.3% of patients were not supported by the mobile emergency unit. CONCLUSION: These results should lead to improved practices, to carry on continuing medical education with all actors in the chain and patient information to shorten up the time of reperfusion.

[Cardiologic emergencies and natural disaster. Prospective study with Xynthia tempest]. / Urgences cardiologiques et catastrophe naturelle. Étude prospective autour de la tempête Xynthia.

BACKGROUND: Stress-induced cardiomyopathy and ischemic cardiopathy have been described after natural disasters such as earthquakes. OBJECTIVES OF THE STUDY: Count stress-induced cardiomyopathies and ischemic cardiopathies just after Xynthia tempest which damaged the Vendean coast on February2010, in order to study epidemiology. PATIENTS AND METHOD: Included patients were living in a tempest damaged village, and admitted in Vendee hospital just after or in the week following the tempest, and presenting a suspected acute coronary syndrome or stress-induced cardiomyopathy. RESULTS: Among 3350 inhabitants of the two damaged Vendean towns, we count three acute coronary syndromes, two Tako-Tsubo cardiomyopathies, and one coronary spasm. We count five women and one man, average age is 76. CONCLUSION: The diagnosis of ischemic cardiopathy and stress-induced cardiomyopathy is over-represented in this tempest damaged population, that have been little described.

[Care of ST elevated myocardial infarction patients in Vendée in 2008: observational and descriptive study]. / Prise en charge des syndromes coronariens aigus avec sus-décalage du segment ST en Vendée en 2008: étude observationnelle descriptive.

PURPOSE OF THE STUDY: Estimating the quality of care of the patients presenting an ST-elevation myocardial infarction in Vendee. PATIENTS AND METHOD: Prospective observational study carried out over the year 2008. Included patients presenting a myocardial infarction for less than 24 hours, they were alive when emergency team arrived, and were taken care of by the SMUR, the emergencies or the cardiology of the hospital of La Roche-sur-Yon. RESULTS: Two hundred and seventeen patients were included, 163 men and 54 women, average age: 65 years. Fifty-six percent of the patients called initially the emergency medical service, half of those within an hour after pain began. Seventy-two percent of them were looked after by a SMUR. Twenty-six percent consulted initially a general practitioner, and one third of those were redirected towards the emergency medical service. Thirty percent of all patients followed the ideal procedure defined by succession of chest pain, emergency medical service call, SMUR, angioplasty or fibrinolysis. The average time between the ECG and the fibrinolysis is 36 minutes, or of the arrival in coronarography room is 105 minutes. The balloon is inflated 42 minutes later. Eighty-six percent of the patients taken care of in the acute phase benefited from a strategy of reperfusion, primary angioplasty (63%) or fibrinolysis (21%). Ninety percent of revascularisations were successful. CONCLUSION: In the case of the chest pain, the emergency medical service is under-used. The number of revascularised patients is satisfactory, but the whole procedure takes too much time, especially when the treatment is the angioplasty.