Identifying Patients at Risk for Prehospital Sudden Cardiac Arrest at the Early Phase of Myocardial Infarction: The e-MUST Study (Evaluation en Médecine d'Urgence des Stratégies Thérapeutiques des infarctus du myocarde)

Nicole Karam¹, Sophie Bataille², Eloi Marijon², Olivier Giovannetti², Muriel Tafflet², Dominique Savary², Hakim Benamer², Christophe Caussin², Philippe Garot², Jean-Michel Juliard², Virginie Pires², Thévy Boche², François Dupas², Gaelle Le Bail², Lionel Lamhaut², François Laborne², Hugues Lefort², Mireille Mapouata², Frederic Lapostolle², Christian Spaulding², Jean-Philippe Empana², Xavier Jouven², Yves Lambert²; e-MUST Study Investigators

Affiliations

¹ From Sudden Death Expertise Center, Paris, France (N.K., E.M., M.T., C.S., J.-P.E., X.J.); Université Paris Descartes, Sorbonne Paris Cité, Paris, France (N.K., E.M., M.T., C.S., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital-APHP, Paris, France (N.K., E.M., C.S., X.J.); Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France (N.K., E.M., O.G., M.T., M.M., C.S., J.-P.E., X.J.); Regional Health Agency of Ile-de-France, Paris, France (S.B.); Emergency Department, Centre Hospitalier Régional d'Orléans, Orléans, France (O.G.); SAMU 74, Réanimation, Annecy, France (D.S.); Cardiology Department, Institut Cardiovasculaire Paris Sud, Massy, France (H.B.); Cardiology Department, Institut Mutualiste Montsouris, Paris, France (C.C.); Cardiology Department, Institut Cardiovasculaire Paris Sud, Quincy sous Sénart, France (P.G.); Cardiology Department, Bichat Hospital-APHP, Paris, France (J.-M.J.); SAMU 77, Melun Hospital, Melun, France (V.P.); SAMU 94, Mondor Hospital-APHP, Créteil, France (T.B.); SAMU 95, Pontoise Hospital, Pontoise, France (F.D.); SAMU 92, Garches Hospital-APHP, Garches, France (G.L.B.); SAMU 75, Necker Hospital-APHP, Paris, France (L.L.); SAMU 91, Sud Francilien Hospital, Corbeil-Essonnes, France (F.L.); Fire Brigade of Paris, Paris, France (H.L.); SAMU 93, Avicenne Hospital-APHP, Bobigny, France (F.L.); and SAMU 78, Versailles Hospital, Le Chesnay, France (Y.L.). nicole_karam@hotmail.com.
² From Sudden Death Expertise Center, Paris, France (N.K., E.M., M.T., C.S., J.-P.E., X.J.); Université Paris Descartes, Sorbonne Paris Cité, Paris, France (N.K., E.M., M.T., C.S., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital-APHP, Paris, France (N.K., E.M., C.S., X.J.); Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France (N.K., E.M., O.G., M.T., M.M., C.S., J.-P.E., X.J.); Regional Health Agency of Ile-de-France, Paris, France (S.B.); Emergency Department, Centre Hospitalier Régional d'Orléans, Orléans, France (O.G.); SAMU 74, Réanimation, Annecy, France (D.S.); Cardiology Department, Institut Cardiovasculaire Paris Sud, Massy, France (H.B.); Cardiology Department, Institut Mutualiste Montsouris, Paris, France (C.C.); Cardiology Department, Institut Cardiovasculaire Paris Sud, Quincy sous Sénart, France (P.G.); Cardiology Department, Bichat Hospital-APHP, Paris, France (J.-M.J.); SAMU 77, Melun Hospital, Melun, France (V.P.); SAMU 94, Mondor Hospital-APHP, Créteil, France (T.B.); SAMU 95, Pontoise Hospital, Pontoise, France (F.D.); SAMU 92, Garches Hospital-APHP, Garches, France (G.L.B.); SAMU 75, Necker Hospital-APHP, Paris, France (L.L.); SAMU 91, Sud Francilien Hospital, Corbeil-Essonnes, France (F.L.); Fire Brigade of Paris, Paris, France (H.L.); SAMU 93, Avicenne Hospital-APHP, Bobigny, France (F.L.); and SAMU 78, Versailles Hospital, Le Chesnay, France (Y.L.).

PMID: 27793995
DOI: 10.1161/CIRCULATIONAHA.116.022954

Identifying Patients at Risk for Prehospital Sudden Cardiac Arrest at the Early Phase of Myocardial Infarction: The e-MUST Study (Evaluation en Médecine d'Urgence des Stratégies Thérapeutiques des infarctus du myocarde)

Nicole Karam et al. Circulation. 2016.

. 2016 Dec 20;134(25):2074-2083.

doi: 10.1161/CIRCULATIONAHA.116.022954. Epub 2016 Oct 28.

Authors

Affiliations

¹ From Sudden Death Expertise Center, Paris, France (N.K., E.M., M.T., C.S., J.-P.E., X.J.); Université Paris Descartes, Sorbonne Paris Cité, Paris, France (N.K., E.M., M.T., C.S., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital-APHP, Paris, France (N.K., E.M., C.S., X.J.); Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France (N.K., E.M., O.G., M.T., M.M., C.S., J.-P.E., X.J.); Regional Health Agency of Ile-de-France, Paris, France (S.B.); Emergency Department, Centre Hospitalier Régional d'Orléans, Orléans, France (O.G.); SAMU 74, Réanimation, Annecy, France (D.S.); Cardiology Department, Institut Cardiovasculaire Paris Sud, Massy, France (H.B.); Cardiology Department, Institut Mutualiste Montsouris, Paris, France (C.C.); Cardiology Department, Institut Cardiovasculaire Paris Sud, Quincy sous Sénart, France (P.G.); Cardiology Department, Bichat Hospital-APHP, Paris, France (J.-M.J.); SAMU 77, Melun Hospital, Melun, France (V.P.); SAMU 94, Mondor Hospital-APHP, Créteil, France (T.B.); SAMU 95, Pontoise Hospital, Pontoise, France (F.D.); SAMU 92, Garches Hospital-APHP, Garches, France (G.L.B.); SAMU 75, Necker Hospital-APHP, Paris, France (L.L.); SAMU 91, Sud Francilien Hospital, Corbeil-Essonnes, France (F.L.); Fire Brigade of Paris, Paris, France (H.L.); SAMU 93, Avicenne Hospital-APHP, Bobigny, France (F.L.); and SAMU 78, Versailles Hospital, Le Chesnay, France (Y.L.). nicole_karam@hotmail.com.
² From Sudden Death Expertise Center, Paris, France (N.K., E.M., M.T., C.S., J.-P.E., X.J.); Université Paris Descartes, Sorbonne Paris Cité, Paris, France (N.K., E.M., M.T., C.S., J.-P.E., X.J.); Cardiology Department, European Georges Pompidou Hospital-APHP, Paris, France (N.K., E.M., C.S., X.J.); Paris Cardiovascular Research Center, INSERM Unit 970, Paris, France (N.K., E.M., O.G., M.T., M.M., C.S., J.-P.E., X.J.); Regional Health Agency of Ile-de-France, Paris, France (S.B.); Emergency Department, Centre Hospitalier Régional d'Orléans, Orléans, France (O.G.); SAMU 74, Réanimation, Annecy, France (D.S.); Cardiology Department, Institut Cardiovasculaire Paris Sud, Massy, France (H.B.); Cardiology Department, Institut Mutualiste Montsouris, Paris, France (C.C.); Cardiology Department, Institut Cardiovasculaire Paris Sud, Quincy sous Sénart, France (P.G.); Cardiology Department, Bichat Hospital-APHP, Paris, France (J.-M.J.); SAMU 77, Melun Hospital, Melun, France (V.P.); SAMU 94, Mondor Hospital-APHP, Créteil, France (T.B.); SAMU 95, Pontoise Hospital, Pontoise, France (F.D.); SAMU 92, Garches Hospital-APHP, Garches, France (G.L.B.); SAMU 75, Necker Hospital-APHP, Paris, France (L.L.); SAMU 91, Sud Francilien Hospital, Corbeil-Essonnes, France (F.L.); Fire Brigade of Paris, Paris, France (H.L.); SAMU 93, Avicenne Hospital-APHP, Bobigny, France (F.L.); and SAMU 78, Versailles Hospital, Le Chesnay, France (Y.L.).

PMID: 27793995
DOI: 10.1161/CIRCULATIONAHA.116.022954

Abstract

Background: In-hospital mortality of ST-segment-elevation myocardial infarction (STEMI) has decreased drastically. In contrast, prehospital mortality from sudden cardiac arrest (SCA) remains high and difficult to reduce. Identification of the patients with STEMI at higher risk for prehospital SCA could facilitate rapid triage and intervention in the field.

Methods: Using a prospective, population-based study evaluating all patients with STEMI managed by emergency medical services in the greater Paris area (11.7 million inhabitants) between 2006 and 2010, we identified characteristics associated with an increased risk of prehospital SCA and used these variables to build an SCA prediction score, which we validated internally and externally.

Results: In the overall STEMI population (n=8112; median age, 60 years; 78% male), SCA occurred in 452 patients (5.6%). In multivariate analysis, younger age, absence of obesity, absence of diabetes mellitus, shortness of breath, and a short delay between pain onset and call to emergency medical services were the main predictors of SCA. A score built from these variables predicted SCA, with the risk increasing 2-fold in patients with a score between 10 and 19, 4-fold in those with a score between 20 and 29, and >18-fold in patients with a score ≥30 compared with those with scores <10. The SCA rate was 28.9% in patients with a score ≥30 compared with 1.6% in patients with a score ≤9 (P for trend <0.001). The area under the curve values were 0.7033 in the internal validation sample and 0.6031 in the external validation sample. Sensitivity and specificity varied between 96.9% and 10.5% for scores ≥10 and between 18.0% and 97.6% for scores ≥30, with scores between 20 and 29 achieving the best sensitivity and specificity (65.4% and 62.6%, respectively).

Conclusions: At the early phase of STEMI, the risk of prehospital SCA can be determined through a simple score of 5 routinely assessed predictors. This score might help optimize the dispatching and management of patients with STEMI by emergency medical services.

Keywords: atherosclerosis; death, sudden, cardiac; myocardial infarction; prognosis.

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Comment in

We must identify patients at risk for pre-hospital sudden cardiac arrest at the early phase of myocardial infarction.
Montero S, Combes A, Schmidt M. Montero S, et al. J Thorac Dis. 2017 Mar;9(3):466-469. doi: 10.21037/jtd.2017.03.30. J Thorac Dis. 2017. PMID: 28449446 Free PMC article. No abstract available.
Letter by Tunçez et al Regarding Article, "Identifying Patients at Risk for Prehospital Sudden Cardiac Arrest at the Early Phase of Myocardial Infarction: The e-MUST Study (Evaluation en Médecine d'Urgence des Stratégies Thérapeutiques des infarctus du myocarde)".
Tunçez A, Ateş MS, Tezcan H. Tunçez A, et al. Circulation. 2017 May 16;135(20):e1046-e1047. doi: 10.1161/CIRCULATIONAHA.117.027631. Circulation. 2017. PMID: 28507256 No abstract available.
Response by Karam et al to Letter Regarding Article, "Identifying Patients at Risk for Prehospital Sudden Cardiac Arrest at the Early Phase of Myocardial Infarction: The e-MUST Study (Evaluation en Médecine d'Urgence des Stratégies Thérapeutiques des infarctus du myocarde)".
Karam N, Bataille S, Marijon E, Tafflet M, Lapostolle F, Spaulding C, Jouven X, Lambert Y; e-MUST Study Investigators. Karam N, et al. Circulation. 2017 May 16;135(20):e1048-e1049. doi: 10.1161/CIRCULATIONAHA.117.027775. Circulation. 2017. PMID: 28507257 No abstract available.

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Identifying Patients at Risk for Prehospital Sudden Cardiac Arrest at the Early Phase of Myocardial Infarction: The e-MUST Study (Evaluation en Médecine d'Urgence des Stratégies Thérapeutiques des infarctus du myocarde)

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Identifying Patients at Risk for Prehospital Sudden Cardiac Arrest at the Early Phase of Myocardial Infarction: The e-MUST Study (Evaluation en Médecine d'Urgence des Stratégies Thérapeutiques des infarctus du myocarde)

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