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Background: The optimal management of patients with ST-segment elevation myocardial infarction (STEMI) presenting late->12 hours following symptom onset-is still under debate.Objectives: The purpose of this study was to describe characteristics, temporal trends, and impact of revascularization in a large population of latecomer STEMI patients.Methods: The authors analyzed the data of 3 nationwide observational studies from the FAST-MI (French Registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction) program, conducted over a 1-month period in 2005, 2010, and 2015. Patients presenting between 12 and 48 hours after symptom onset were classified as latecomers.Results: A total of 6,273 STEMI patients were included in the 3 cohorts, 1,169 (18.6%) of whom were latecomers. After exclusion of patients treated with fibrinolysis and patients deceased within 2 days after admission, 1,077 patients were analyzed, of whom 729 (67.7%) were revascularized within 48 hours after hospital admission. At 30-day follow-up, all-cause death rate was significantly lower among revascularized latecomers (2.1% vs 7.2%; P < 0.001). After a median follow-up of 58 months, the rate of all-cause death was 30.4 (95% CI: 25.7-35.9) per 1,000 patient-years in the revascularized latecomers group vs 78.7 (95% CI: 67.2-92.3) per 1,000 patient-years in the nonrevascularized latecomers group (P < 0.001). In multivariate analysis, revascularization of latecomer STEMI patients was independently associated with a significant reduction of mortality occurrence during follow-up (HR: 0.65 [95% CI: 0.50-0.84]; P = 0.001).Conclusions: Coronary revascularization of latecomer STEMI patients is associated with better short and long-term clinical outcomes. [ABSTRACT FROM AUTHOR]

Background and Aim: It was hypothesized that the pattern of coronary occlusion (thrombus composition) might contribute to the onset of ventricular arrhythmia and sudden cardiac death (SCD) in myocardial infarction (MI).Methods: The TIDE (Thrombus and Inflammation in sudden DEath) study included patients with angiographically-proven acute coronary occlusion as the cause of a ST elevation MI (STEMI) complicated by Sudden Cardiac Death (SCD group) or not (STEMI group). Thrombi were obtained by thrombo-aspiration before primary percutaneous coronary stenting and analyzed with a quantitative method using scanning electron microscopy. We compared the composition of the thrombi responsible for the coronary occlusion between the two groups and evaluated factors influencing its composition.Results: We included 121 patients and found that thrombus composition was not different between the SCD group (n=23) and the STEMI group (n=98) regarding content of fibrin fibers (60.3±18.4% vs. 62.4±18.4% respectively, p=0.68), platelets (16.3±19.2% vs. 15.616.7±%, p=0.76), erythrocytes (14.6±12.5% vs. 13±12.1%, p=0.73) and leukocytes (0.6±0.9% vs. 0.8±1.5%, p=0.93). Thrombus composition did not differ between patients receiving upstream-use of glycoprotein IIb/IIIa platelet receptor inhibitors (GPI) and patients free of GPI. The only factor found to influence thrombus composition was the ischemic time from symptom onset to primary PCI, with a decreased content in fibrin fibers (57.8±18.5% vs. 71.9±10.1%, p=0.0008) and a higher platelet content (19.2±19.1% vs. 7.9±5.7% p=0.014) in early presenters (<3h of ischemic time) vs. late presenters (>6h of ischemic time).Conclusion: Composition of intracoronary thrombi in STEMI patients does not differ between those presenting with and without SCD. Time from symptom onset to coronary reperfusion seems to be the strongest factor influencing thrombus composition in MI. [ABSTRACT FROM AUTHOR]

Abstract: Background: Chest pain (CP) is a common complaint among patients presenting to the emergency department (ED). Previous studies suggest that between 2% and 5% of ED patients who present with CP and are sent home develop an acute coronary syndrome within 30 days. In France, no prospective data are available concerning the outcome of CP patients discharged from the ED. Objective: The objective of our study was to determine the rate of adverse cardiac events (ACE) within a period of 60 days after discharge from the ED. Methods: From October 2007 to February 2008, consecutive patients aged 25 years or more who presented to the ED with CP were prospectively included. Patients discharged from the ED were contacted by phone at 60 days to determine their clinical course and the occurrence of an ACE. Results: There were 322 CP patients enrolled, representing 3.9% of all medical admissions to the ED; 40.4% of these patients were hospitalized and 59.6% were discharged. Three patients (1.6%) could not be contacted for follow-up, leaving 189 patients eligible for the study. The rate of ACE was 3.7%: one ST-segment elevation myocardial infarction and six non-ST-segment elevation myocardial infarctions. Follow-up revealed that 39.1% of patients saw a cardiologist and that 14.2% were readmitted for CP. Conclusion: We found that CP is a frequent complaint in patients who present to our ED, and that a small proportion (3.7%) is mistakenly discharged and presents with an ACE during the 60-day follow-up period. [Copyright &y& Elsevier]

Abstract: 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 24hours, 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 practitionner, 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 36minutes, or of the arrival in coronarography room is 105minutes. The balloon is inflated 42minutes 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. [Copyright &y& Elsevier]

Abstract: Background: Search and rescue helicopters from the French navy conduct ambulance and search and rescue missions near the western coast of the French Britain. The team on board includes military doctor and paramedic. Operations in this area are challenging due to long distances and severe weather conditions. Methods: We studied retrospectively 205 search and rescue missions from 2000 to 2007 with special emphasis on acute heart disease and operative conditions. Results: 12.2% of the missions (25/205) concern acute heart disease dominated by myocardial infarction elevation myocardial infarction. All of the patients are male. Most of them are seafarers and the others come from ferries with a median age of 53.4 years. Sixty-two percent of the missions were carried in darkness. The median range is about 80 nautical miles. Two patients died during search and rescue missions. All patient are hospitalized. Conclusion: Ambulance and search and rescue mission near the western coasting of the French Britain are a challenge. Using a heavy helicopter from French Navy was the best way to carry medical treatment to seafarers and passengers of ferries suffering from acute heart disease. [Copyright &y& Elsevier]

Abstract: In France, the incidence of myocardial infarctions leading to hospitalisations can be estimated between 60,000 and 65,000 each year. With the addition of cases of unstable angina, about 80,000 to 100,000 hospital stays each year are caused by acute coronary syndromes. Cases of out-of-hospital cardiac arrest of ischaemic origin should also be taken into account when estimating the annual incidence of myocardial infarction. In Europe, a North-South gradient, and even more an East-West gradient is observed for the incidence of ischaemic heart disease, with the highest figures found in central and eastern European countries. A consistent trend to a decrease in the incidence of myocardial infarction is observed on both sides of the Atlantic. In parallel, progress in the management of acute coronary syndromes has led to a marked decrease in early case fatality rates. Overall, these trends explain the spectacular decrease in cardiovascular mortality observed over the past 25 years in most European countries. Acute coronary syndromes, however, remain severe clinical conditions, which carry a high mid-term and long-term morbi-mortality and deserve further efforts to develop new therapeutic tools. [ABSTRACT FROM AUTHOR]