Management of Acute Myocardial Infarction in Intensive Care Units in 1995: A Nationwide French Survey of Practice and Early Hospital Results
Identifieur interne : 001D81 ( Main/Exploration ); précédent : 001D80; suivant : 001D82Management of Acute Myocardial Infarction in Intensive Care Units in 1995: A Nationwide French Survey of Practice and Early Hospital Results
Auteurs : Nicolas Danchin [France] ; Laurent Vaur [France] ; Nathalie Genès [France] ; Maguy Renault [France] ; Jean Ferrières [France] ; Sylvie Etienne [France] ; Jean-Pierre Cambou [France]Source :
- Journal of the American College of Cardiology [ 0735-1097 ] ; 1997.
English descriptors
Abstract
Objectives. This survey sought to determine actual practices in the management of acute myocardial infarction on a nationwide scale.Background. Few data are available regarding the adoption of clinical trial results of treatment of myocardial infarction into “real-world” clinical practice.Methods. Of 501 intensive care units in France, 373 (74%) collected data from all patients with myocardial infarction admitted within 48 h of symptom onset during November 1995.Results. Data from 2,563 patients (71% men; mean age [±SD] 67 ± 14 years) were included. Time from symptom onset to admission was <6 h in 1,467 patients (62%). Thrombolysis was used in 822 patients (32%) and primary angioplasty in 330 (13%). The use of reperfusion therapy decreased markedly with age. During the first 5 days, heparin was prescribed in 96% of patients, aspirin in 89%, nitrates in 87%, beta-adrenergic blocking agents in 64%, angiotensin-converting enzyme inhibitors in 46% and calcium antagonists in 17%. Coronary angiography was performed in 33% of patients, and 58% had echocardiographic assessment of left ventricular ejection fraction (LVEF). Median LVEF was 50%. The 5-day mortality rate was 7.7% compared with 12.1% in a previous French survey carried out in 1984. By multivariate analysis, independent predictors of mortality were age, anterior infarction, history of stroke and heart failure and, when added to the model, Killip class and LVEF.Conclusions. This survey shows that the results of therapeutic trials have largely translated to clinical practice, resulting in improved early outcome compared with the early 1980s. However, continuous efforts should be made to shorten the time delay before hospital admission and to increase the proportion of elderly patients receiving reperfusion therapy.
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DOI: 10.1016/S0735-1097(97)00371-9
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xml:lang="en"><term>ACE</term><term>ECG</term><term>GUSTO-1</term><term>LV</term><term>LVEF</term><term>MITI</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Objectives. This survey sought to determine actual practices in the management of acute myocardial infarction on a nationwide scale.Background. Few data are available regarding the adoption of clinical trial results of treatment of myocardial infarction into “real-world” clinical practice.Methods. Of 501 intensive care units in France, 373 (74%) collected data from all patients with myocardial infarction admitted within 48 h of symptom onset during November 1995.Results. Data from 2,563 patients (71% men; mean age [±SD] 67 ± 14 years) were included. Time from symptom onset to admission was <6 h in 1,467 patients (62%). Thrombolysis was used in 822 patients (32%) and primary angioplasty in 330 (13%). The use of reperfusion therapy decreased markedly with age. During the first 5 days, heparin was prescribed in 96% of patients, aspirin in 89%, nitrates in 87%, beta-adrenergic blocking agents in 64%, angiotensin-converting enzyme inhibitors in 46% and calcium antagonists in 17%. Coronary angiography was performed in 33% of patients, and 58% had echocardiographic assessment of left ventricular ejection fraction (LVEF). Median LVEF was 50%. The 5-day mortality rate was 7.7% compared with 12.1% in a previous French survey carried out in 1984. By multivariate analysis, independent predictors of mortality were age, anterior infarction, history of stroke and heart failure and, when added to the model, Killip class and LVEF.Conclusions. This survey shows that the results of therapeutic trials have largely translated to clinical practice, resulting in improved early outcome compared with the early 1980s. However, continuous efforts should be made to shorten the time delay before hospital admission and to increase the proportion of elderly patients receiving reperfusion therapy.</div></front></TEI><affiliations><list><country><li>France</li></country><region><li>Grand Est</li><li>Lorraine (région)</li></region><settlement><li>Nancy</li><li>Toulouse</li><li>Vandoeuvre-lès-Nancy</li><li>Vandœuvre-lès-Nancy</li></settlement></list><tree><country name="France"><noRegion><name sortKey="Danchin, Nicolas" sort="Danchin, Nicolas" uniqKey="Danchin N" first="Nicolas" last="Danchin">Nicolas Danchin</name></noRegion><name sortKey="Cambou, Jean Pierre" sort="Cambou, Jean Pierre" uniqKey="Cambou J" first="Jean-Pierre" last="Cambou">Jean-Pierre Cambou</name><name sortKey="Danchin, Nicolas" sort="Danchin, Nicolas" uniqKey="Danchin N" first="Nicolas" last="Danchin">Nicolas Danchin</name><name sortKey="Danchin, Nicolas" sort="Danchin, Nicolas" uniqKey="Danchin N" first="Nicolas" last="Danchin">Nicolas Danchin</name><name sortKey="Etienne, Sylvie" sort="Etienne, Sylvie" uniqKey="Etienne S" first="Sylvie" last="Etienne">Sylvie Etienne</name><name sortKey="Ferrieres, Jean" sort="Ferrieres, Jean" uniqKey="Ferrieres J" first="Jean" last="Ferrières">Jean Ferrières</name><name sortKey="Genes, Nathalie" sort="Genes, Nathalie" uniqKey="Genes N" first="Nathalie" last="Genès">Nathalie Genès</name><name sortKey="Renault, Maguy" sort="Renault, Maguy" uniqKey="Renault M" first="Maguy" last="Renault">Maguy Renault</name><name sortKey="Vaur, Laurent" sort="Vaur, Laurent" uniqKey="Vaur L" first="Laurent" last="Vaur">Laurent Vaur</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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