Determinants and prognostic impact of compliance with guidelines in reperfusion therapy for ST-segment elevation myocardial infarction: results from the ESTIM Midi-Pyrénées Area.

BACKGROUND: Early reperfusion therapy has proven benefit in reducing mortality in patients with ST-segment elevation myocardial infarction (STEMI). Expert guideline committees have defined recommendations to improve the management of patients with STEMI and decrease their mortality rates.

AIMS: To identify predictors of compliance with American College of Cardiology/American Heart Association guidelines for reperfusion therapy in STEMI and to determine the prognostic impact of compliance.

METHODS: ESTIM Midi-Pyrénées was a multidisciplinary, prospective registry in patients with STEMI, conducted between June 2001 and June 2003 in French hospitals. Data were analysed from 1277 patients managed by emergency physicians in the prehospital system or emergency room and/or cardiologists in interventional or non-interventional cardiology departments.

RESULTS: A revascularization strategy was performed in 89.4% of patients; treatment complied with the guidelines in 61.1% of patients. After multivariable analysis, factors associated with compliance were age less or equal than 75years (odds ratio [OR] 1.56, 95% confidence interval [CI] 1.18-2.08), symptom onset during the day (OR 1.43, 95% CI 1.12-1.82), typical electrocardiographic symptoms of STEMI (OR 3.2, 95% CI 2.19-4.5), and initial medical contact. After adjustment for confounders, 1-month mortality was significantly lower in patients managed according to guideline recommendations (OR 0.60, 95% CI 0.40-0.92).

CONCLUSION: A number of factors can be used to identify STEMI patients who are less likely to be managed according to guidelines. Training focused on these factors should improve management and clinical outcomes of STEMI.