ObjectivesWe hypothesised that patients having experienced one coronary event in their life were susceptible to present differences in their pathways of care and within 1 year of their life courses. We aimed to compare pathways between first-time ST-elevation myocardial infarction (STEMI) and STEMI with prior myocardial infarction (MI).DesignA retrospective observational study based on the Observatoire des Syndromes Coronariens Aigus du réseau RESCUe (OSCAR) registry collecting all suspected STEMI from 10 percutaneous coronary intervention centres in France.SettingAll patients with STEMI from 2013 to 2017 were included (N=6306 with 5423 first-time STEMI and 883 STEMI with prior MI). We provided a matching analysis by propensity score based on cardiovascular risk factors.ParticipantsWe defined first-time STEMI as STEMI occurring at the inclusion date, and STEMI with prior MI as STEMI with a history of MI prior to the inclusion date.ResultsPatients with first-time STEMI and patients with STEMI with prior MI were equally treated during hospitalisation and at discharge. At 12 months, patients with first-time STEMI had a lower adherence to BASIC treatment (ie, beta-blocker, antiplatelet therapy, statin and converting enzyme inhibitor) (48.11% vs 58.58%, p=0.0167), more frequently completed the cardiac rehabilitation programme (44.33% vs 31.72%, p=0.0029), more frequently changed their lifestyle behaviours; more frequently practiced daily physical activity (48.11% vs 35.82%, p=0.0043) and more frequently stopped smoking at admission (69.39% vs 55.00%, p=0.0524). The estimated mortality was higher for patients with STEMI with prior MI at 1 month (p=0.0100), 6 months (p=0.0500) and 1 year (p=0.0600).ConclusionsWe provided an exhaustive overview of the real-life clinical practice conditions of STEMI management. The patients with STEMI with prior MI presented an optimised use of prehospital resources, which was probably due to their previous experience, and showed a better adherence to drug therapy compared with patients with first-time STEMI.Trial registration numberCommission Nationale de l’Informatique et des Libertés (number 2 013 090 v0).

Background We hypothesized that patients having experienced one coronary event in their life must present differences in their pathway of care in the acute phase and within 12-month life course. Purpose This study aimed to compare pathways between current and recurrent Myocardial Infarction. Methods All patients from the OSCAR registry with ST Elevation Myocardial Infarction (STEMI) as final diagnosis from 2013 to 2016 were included. We defined recurrent STEMI as a reinfarction occurring within 12-month post-current-STEMI and STEMI with prior MI occurred before the inclusion date. Results Recurrent STEMI called more often the medical dispatch center (71.32% vs 62.36%, p<0.0001) and benefited from out-of-hospital medical care by Emergency Mobile Services (67.07% vs 59.70%, p=0.0007). The hospital management delays did not differ but the delay symptom-ECG tended to be 26 minutes longer for recurrent STEMI admitted directly to the emergency department (182 [109; 314] vs 156 [89; 291], p=0.0510). They also underwent less percutaneous coronary interventions (PCI) (90,24% vs 95,07%, p<0.0001). At 12 months post-discharge, we observed a better adherence to BASIC-treatment (Beta-blockers, Anti-platelet medications [aspirin, clopidogrel, prasugrel], Statins and Converting Enzyme Inhibitor Combination-treatment) for recurrent STEMI (64,06% vs 52,98%, p=0.0062) but the key lifestyle interventions were less applied. Conclusion Comparison of care and life course of current and recurrent STEMI highlighted a different use of pre-hospital care and hospital resources. They also showed better adherence to BASIC-treatment during recurrent events compared to current STEMI. Acknowledgement/Funding The RESCUe Network is funded by the Regional Agency for Health from Auvergne-Rhône-Alpes region (Agence Régionale de Santé Auvergne-Rhône-Alpes).