[Initial management of ST-elevation myocardial infarction in 2014: From guidelines to practices, survey of 176 French interventional cardiologists]

Abstract

Background: Real life management of myocardial infarction has not recently been evaluated in France.

Aims: To describe ST-elevation myocardial infarction management in France in 2014 and to compare it with current guidelines.

Methods: A multicentre study was performed. An e-mail questionnaire was sent to French interventional cardiologists. Demographic data of interventional cardiologists, procedural aspects of percutaneous coronary intervention, antithrombotic treatments and patient rehabilitation have been investigated.

Results: One hundred and seventy-six answers were analysed. Most of centres realized more than 600 annual angioplasties. An average of 209 myocardial infarctions were managed per centre in 2014, more often in academic than in general or private centres (respectively 51, 32 and 17% of infarctions). Anti-GPIIbIIIa (34% of the cases) and thromboaspiration were not systematic but depend on patient's characteristics, according to guidelines. Radial access was favoured in 85% of the cases and increased for the last decade. Drug eluting stents were used in 62% of cases. Unfractionated heparin and enoxaparine accounted for more than 80% of anticoagulants treatments. Overall, use of clopidogrel was as high as that of prasugrel or ticagrelor although clopidogrel is recommended in second-line. Cardiovascular rehabilitation was proposed to more than 50% of patients.

Conclusion: In spite of heterogeneity of ST-elevation myocardial infarction management in 2014, real-life practices generally comply with current guidelines.

Keywords: Acute coronary syndrome; Angioplastie coronaire transluminale percutanée; Infarctus myocardique; Myocardial infarction; Percutaneous transluminal coronary angioplasty; Platelet aggregation inhibitors; Syndrome coronaire aigu avec sus-décalage du segment ST; Thromboaspiration; Traitements antiagrégants.