Identifying key factors leading to the optimal care pathway for patients with ST-segment elevation myocardial infarction: Results from the RESCAMIP registry

Summary Background In France, when someone presents with chest pain, it is recommended to call a health emergency number. The patient talks with an emergency doctor at a medical dispatch centre, who decides whether (or not) to send a Mobile Intensive Care Unit (MICU). Patients with an ST-segment elevation myocardial infarction (STEMI) should have an MICU as their first medical contact, to speed up confirmation of diagnosis and enable them to benefit from reperfusion therapy as quickly as possible. Aim To evaluate the proportion of patients with STEMI benefiting from an optimal care pathway, and to identify the key factors leading to this pathway. Methods RESCAMIP was a multicentre registry conducted between May 2015 and May 2017 in Midi-Pyrenees. All patients treated for STEMI within 12 hours of symptoms onset, without initially going into cardiac arrest, were included. Results Data from 1371 patients with STEMI were analysed; 60% had an MICU as their first medical contact. In-hospital mortality was 4%. Factors associated with calling the medical dispatch centre when presenting chest pain were: age > 65 years (odds ratio [OR] 1.37, 95% confidence interval [CI] 1.02–1.83), personal history of cardiovascular disease (OR 1.9, 95% CI 1.22–2.96) and having cardiovascular risk factors (OR 1.84, 95% CI 1.35–2.5). Factors associated with sending an MICU as first medical contact were: male sex (OR 2.11, 955 CI 1.49–2.99) and personal history of cardiovascular disease (OR 1.69, 95% CI 1.07–2.65). Conclusions The proportion of patients with STEMI going through non-optimal pathways was 40% in our area. We note that there are sex-based inequalities in accessing MICUs.