High risk hypertensives: pre-hospital management of acute myocardial infarction—results from the French nationwide registry USIC 2000

Objective. – To assess the use of mobile coronary care units (MCU) in hypertensive patients previously treated for cardiovascular diseases in comparison with those with no history of cardiovascular disease and to estimate the influence of the use of MCU on cardiovascular outcome in this population.Patients. – We used a nationwide prospective registry of all patients admitted for AMI in French intensive care units in 2000. Patients without history of hypertension or patients admitted with pulmonary oedema or cardiogenic shock were excluded. Men (N = 514) and women (N = 291) were analysed separately.Results. – The proportion of patients with history of myocardial infarction, peripheral artery disease and stroke was not significantly higher in subjects who used physician-staffed MCU as compared with patients with no history of myocardial infarction, peripheral artery disease or stroke. In each sex, revascularization (pre hospital fibrinolysis, in hospital fibrinolysis or coronary angioplasty) were more frequent in patients who used MCU. Also, one year cardiovascular mortality was lower in men who used MCU.Conclusion. – known high risk hypertensive patients did not use physician-staffed MCU more than subjects free of such condition. Education of hypertensive patients at risk during routine visits is required to increase of the use of physician-staffed MCU in case of symptoms suggestive of AMI.

RésuméL'objectif de ce travail a été de comparer la prise en charge préhopsitalière par les Samu chez des patients hypertendus à risque, avec ou sans antécédent cardiovasculaire. À partir du registre des infarctus USIC 2000, les patients hypertendus sans signes d'œdème pulmonaire ou de choc cardiogénique à l'admission ont été sélectionnés. La population a compris 514 hommes et 291 femmes. Le recours au Samu n'a pas été différent, que les patients aient ou non des antécédents cardiovasculaires (infarctus, artériopathie périphérique, accident vasculaire cérébral). Les traitements de reperfusion par thrombolyse ou angioplastie sont plus souvent utilisés chez les patients ayant eu recours au Samu. La mortalité à un an, la plus faible, est constatée chez les hommes ayant eu recours au Samu. Ainsi, dans cette population hypertendue, il paraît indispensable d'améliorer l'éducation des patients pour favoriser l'appel au 15 en cas de symptômes pouvant évoquer un infarctus en voie de constitution.