Out-of-hospital management and outcomes of patients with ST-segment elevation myocardial infarction (STEMI) within 12 hours, from April to October 2021, on La Réunion island

Abstract

Introduction

The management of STEMI is well standardized through European guidelines. However, various factors can hinder its implementation, particularly on Réunion Island, due to its geographical features and the high prevalence of diabetes and obesity.

Objective

The primary outcome is to assess the conformity of timing and treatments for patients managed for ST-segment elevation myocardial infarction (STEMI) evolving for less than 12 hours according to the guidelines. This study also analyzed specific management practices among women, patients over 75 years old, and those who received thrombolysis.

Method

This multicenter retrospective study was conducted from April to October 2021 in La Réunion. 517 files were analyzed, 258 of which were ST-segment elevation myocardial infarctions (STEMIs), and among them, 180 had pain evolving for less than 12 hours, and 160 were complete.

Results

160 patients were included (median age: 60 years (IQR: 55; 67.2); 29% were women; 29% had prior angina; 32% received thrombolysis therapy). Management was in accordance with guidelines for 66 patients (41%): recommended treatment and timing were met in 127 (79%) and 77 patients (48%) respectively. However, it was significantly less appropriate for women (17% vs. 45%; p < 0.001) and those over 75 years old (8%; p < 0.01), with 24% receiving thrombolysis. Overall mortality at 28 days (3%) and 1 year (7%) did not differ based on the quality of management.

Conclusion

The management of STEMI could be improved on Réunion Island, especially among women and elderly individuals.