[Delays of treatment of acute myocardial infarction with ST elevation admitted to the CCU (coronary care unit) in Alsace]. / Délais de prise en charge de l'infarctus aigu du myocarde avec sus-décalage persistant du segment ST admis dans les USIC d'Alsace.

OBJECTIVE: to determine the time delay from symptom onset to diagnosis and treatment of patients with persistant ST segment elevation myocardial infarction (STEMI). DESIGN: prospective observational study. METHOD: patients with symptoms onset < 24 h admitted in all 10 cardiac intensive care units in one French administrative region (Alsace). Data were recorded by doctors on duty soon after hospital admission. Patients with STEMI during hospital stay or as a complication of cardiac interventional procedure were excluded. The Kruskal-Wallis test was used to assess statistical differences between the groups (p value < 0.05). RESULT: from April to October 2004, 326 patients were admitted for STEMI. Median time between the symptoms onset and the patient's call for medical help was 60 minutes. General practitioners were the first medical contact in 41%. The time from symptoms onset to first medical intervention and from first medical intervention to coronary care unit admission were markedly shorter in patients who had directly called the Emergency Medical Services (group 15-110 patients i.e. 33% of the study population): 44 min vs 75 min otherwise (p=0,003). Median transport time was 60 min. Sixty two percent of the pts were transported by the Emergency Medical Services. The median time from symptoms onset to initiation of reperfusion therapy was 240 min. It was significantly lower in group 15 (170 min vs 286 min - p < 0,001) and for thrombolytic therapy (190 min versus 245 min for primary angioplasty, p=0,007). When thrombolysis (THL) was used, 89% of the pts could be treated during 6 hours of symptoms onset and 44% in 3 hours. For angioplasty only 4% of the pts were treated in the first 90 minutes, 9% in the 2 hours and 30% in the 3 hours of symptoms onset. If the time delay is evaluated from the 1 st medical intervention, call to reperfusion intervention was significatly shorter for THL: 91 versus 157 min, p< 0,003. Angioplasty represented 75% of reperfusion strategy in our area and THL alone only 2,7% and combine therapy 5,4%. CONCLUSION: our study documents the beneficial effect of a direct call to Emergency Medical Services. Our results also underscore the need for an effort to reduce the time to offer the best appropriate reperfusion techniques in STEMI pts: speed up the admission in the cath-lab, think about pre-hospital thrombolysis followed by coronary angioplasty if necessary.

Letter visibility and word recognition: the optimal viewing position in printed words.

It has repeatedly been shown that the time and accuracy of recognizing a word depend strongly on where in the word the eye is fixating. Word-recognition performance is maximal when the eye fixates a region near the word's center, and decreases to both sides of this "optimal viewing position." The reason for this phenomenon is assumed to be the strong drop-off of visual acuity: the visibility of letters decreases with increasing eccentricity from fixation location. Consequently, fewer letters can be identified when the beginning or ending of a word is fixated than when its center is fixated. The present study is a test of this visual acuity hypothesis. If the phenomenon is caused by letter visibility, then it should be sensitive to variations of visual conditions in which the letters are presented. By increasing the interletter distances of the word (e.g., a_t_t_e_m_p_t), letter visibility was decreased. As expected from our hypothesis, the viewing-position effect became more exaggerated. An additional experiment showed that destroying word-shape information (e.g., aTtEmPt) decreased overall word-recognition performance but had no influence on the viewing-position effect. Varying the viewing position in words might thus be used as a paradigm, allowing one to separate out the contribution of letter information and supraletter information to word recognition.