Le registre FACT (enquete FrAncaise observationnelle sur la prise en Charge des patients ayanT un syndrome coronaire aigu), constitue le registre francais ayant a ce jour inclus le plus grand nombre de patients.Objectifs. - Le recueil de donnees epidemiologiques, des modalites et delais de prise en charge medicale prehospitaliere et hospitaliere ainsi que des donnees evolutives des syndromes coronaires aigus.Methode. -Trois mille neuf cent deux patients ont ete inclus dans FACT entre le 6 janvier 2003 et le 3 fevrier 2003 par 362 centres de cardiologie francais. De ce registre ont ete isoles 1810 patients admis dans des services de cardiologie appartenant a des centres hospitaliers generaux qui representaient 50,8 % de l'ensemble des centres investigateurs. Dans un souci de clarification les patients ont ete classes en trois groupes : groupe A : patients sans sus-decalage de ST mais avec des modifications evocatrices de l'electrocardiogramme ; groupe B : patients avec sus-decalage de ST ; groupe C : tous les autres patients. Les resultats ont ete surtout etudies pour les groupes A et B et compares entre eux, confrontes a ceux de l'ensemble du registre FACT et des autres registres.Resultats. - Les resultats montrent que le delai moyen de prise en charge est de 2,9 heures apres un delai entre le symptome et le premier appel de 6,7 heures, que le premier intervenant est un medecin generaliste (36,4 %), le Samu (31,6 %), le service d'urgence (18,7 %). La thrombolyse prehospitaliere des patients du groupe B est effectuee dans 16,6 % des cas. Les recommandations de la societe europeenne de cardiologie sont largement suivies sauf pour les plus recentes puisque seulement 27,6 % des patients du groupe A ayant un Timi score superieur ou egal a 5 beneficient d' un traitement par anti-GPIIB IIIA. Les motifs de non-prescription des differentes classes recommandees sont lies pour la plupart a des contre-indications ou intolerances. La strategie de desocclusion coronarienne est principalement dictee par la presence sur le site d'un plateau d'angioplastie disponible avec dans ce cas un taux d'angioplastie primaire de 54,2 % pour 7,9 % de thrombolyse contre a l'oppose 8,3 % d'angioplastie et 54,2 % de thrombolyse pour les centres non equipes. La mortalite globale a ete de 5,8 % mais varie de facon inversement proportionnelle au niveau d'equipement des services allant de 5,9 % pour les services avec angioplastie, 11 % pour les services avec coronarographie sans angioplastie a 13,8 % pour les services sans plateau technique. Cependant les patients accueillis sont differents en particulier du fait de leur age d'autant plus eleve que le service d'accueil est moins equipe, influencant ainsi l'ecart de mortalite.Conclusion. - A partir du registre FACT et des donnees propres aux centres hospitaliers generaux, il est possible de reflechir aux possibilites d'ameliorer les delais d'appel au premier intervenant en particulier au centre 15, numero d'appel unique francais du SAMU, de mieux amenager la repartition geographique d'acces aux plateaux techniques d'angioplastie et de renforcer l'adhesion des cardiologues aux recommandations en les convainquant d'un rapport benefice/risque favorable de certains traitements.
The FACT registry is currently the French registry including the greatest number of patients with acute coronary syndromes.Purpose.- The study presents epidemiologic data, modalities and delays for medical admission.Method.- Three thousand nine hundred and two patients were included in FACT by 362 French centers of cardiology between 06/01/2003 and 03/02/2003. One thousand eight hundred and ten patients, who had been placed in the cardiology departments of French general hospitals, were isolated from this registry. The French general hospitals represented 50.8% of the 362 centers. In order to clarify the study, these patients were divided into three groups: group A: patients without ST segment elevation but with suggestive ECG modifications; group B: patients with ST segment elevation; group C: all other patients. The results were mainly studied for groups A and B and compared. These results were also compared to those of the FACT registry and of other registries.Results.- The results show that the average delay for admission is 2.9 h after a first delay between the pain and the help of 6.7 h. The first intervening party is a general practitioner (36.4%) then the SAMU (31.6%) and finally the emergency departments (18.7%). 16.6% of the patients from group B undergo pre-hospital thrombolysis. The recommendations of the European Society of Cardiology are widely applied except for the most recent of them since only 27.6% of the patients from group A having a TIMI score >= 5 receive an anti-GIIB IIIA treatment. The reasons of the non-prescription of the recommended classes are mostly linked to contra-indication and intolerance. The strategy of coronary reopening mainly depends on the presence or the absence in the department of an available medical equipment for angioplasty. If there is one, the percentage of primary angioplasty reaches 54.2% and the percentage of thrombolysis 7.9%. On the opposite, there is 8.3% of angioplasty and 54.2% of thrombolysis for the unequipped centers. The global mortality reaches 5.8% but is inversely proportional to the level of equipment of the departments: 5.9% for the departments with angioplasty, 11% for the departments with coronarography but without angioplasty and 13.8% for the departments without any interventional equipment. Nevertheless, the age of the patients is different and this influences the results: we notice that the less equipped the department is, the older the patients are.Conclusion.- The FACT registry and the data from the general hospitals give the opportunity to think about the possibilities to improve the delays of call to the first intervening party (more particularly to the SAMU) but it also allows us to think about how to better organize the geographical distribution giving access to a medical equipment for angioplasty. All these information will also help the cardiologists to gather around the recommendations by convincing them that the benefit/risk ratio is positive.