MANAGEMENT OF ACUTE MYOCARDIAL-INFARCTION IN INTENSIVE-CARE UNITS IN 1995 - A NATIONWIDE FRENCH SURVEY OF PRACTICE AND EARLY HOSPITAL RESULTS

Objectives. This survey sought to determine actual practices in the ma nagement of acute myocardial infarction on a nationwide scale. Backgro und. Few data are available regarding the adoption of clinical trial r esults of treatment of myocardial infarction into ''real-world'' clini cal practice. Methods. Of 501 intensive care units in France, 373 (74% ) collected data from all patients with myocardial infarction admitted within 48 h of symptom onset during November 1995. Results. Data from 2,563 patients (71% men; mean age [+/-SD] 67 +/- 14 years) were inclu ded. Time from symptom onset to admission was <6 h in 1,467 patients ( 62%). Thrombolysis was used in 822 patients (32%) and primary angiopla sty in 330 (13%). The use of reperfusion therapy decreased markedly wi th age. During the first 5 days, heparin was prescribed in 96% of pati ents, aspirin in 89%, nitrates in 87%, beta adrenergic blocking agents in 64%, angiotensin-converting enzyme inhibitors in 46% and calcium a ntagonists in 17%. Coronary angiography was performed in 33% of patien ts, and 58% had echocardiographic assessment of left ventricular eject ion fraction (LVFF). Median LVEF was 50%. The 5 day mortality rate was 7.7% compared with 12.1% in a previous French survey carried out in 1 984. By multivariate analysis, independent predictors of mortality wer e age, anterior infarction, history of stroke and heart failure and, w hen added to the model, Killip class and LVEF. Conclusions. This surve y shows that the results of therapeutic trials have largely translated to clinical practice, resulting in improved early outcome compared wi th the early 1980s. However, continuous efforts should be made to shor ten the time delay before hospital admission and to increase the propo rtion of elderly patients receiving reperfusion therapy. (C) 1997 by t he American College of Cardiology.