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Master thesis

Evaluation de la stratégie thérapeutique du syndrome coronarien aigu sans sus-décalage persistant du segment ST au SAMU 54 et aux urgences du CHU de Nancy

Abstract : Background : The management of patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) is based on early risk stratification of both ischemic and bleeding events. The 2007 guidelines from the European society of cardiology describe the treatment options for anticoagulants and antiplatelet agents and urge physicians to establish whether patients are at high or low risk. The need for, and timing of an invasive strategy has to be tailored according to the acuteness of risk. At the University Hospital of Nancy, a standard operating procedure (SOP) has been established in July 2008, recommending fondaparinux in non-urgent situations. Methods : In a retrospective (01/01/08-30/06/08) and prospective (01/01/09-30/06/09) study, we enrolled 181 patients presenting with NSTE-ACS in mobile intensive care units of SAMU 54 or in the emergency department at the University Hospital of Nancy. Our aim was toevaluate the process of care as weil as efficacy and safety of treatment.Results : The mean age of our patients was 67 years with a clear prevalence of male patients (sex ratio 2,18). The median time from symptom-onset to 1 st medical contact for prehospital management was 114 minutes. Anticoagulants and antiplatelet agents were used in only three-quarters of patients. Especially those patients at high risk didn't benefit enough from adequate therapy. Management strategies were in accordance with the guidelines. There was a reduction of 77% in the secondary outcome of bleeding events by applying the new SOP as compared to standard anticoagulation therapy. However, the difference was not statistically significant. Conclusion : Although initial risk assessment and transfer delays were efficient, the first-line treatment is insufficient in our series. The treatment modalities based on the new SOP have shown to be effective and safe without increasing the risk of occurrence of hemorrhagic or ischemic side effects.
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https://hal.univ-lorraine.fr/hal-01732497
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Marc Gallion. Evaluation de la stratégie thérapeutique du syndrome coronarien aigu sans sus-décalage persistant du segment ST au SAMU 54 et aux urgences du CHU de Nancy. Sciences du Vivant [q-bio]. 2009. ⟨hal-01732497⟩

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