Résumé
Objectif
Le diagnostic d’infarctus du myocarde (IDM) est difficile en préhospitalier. Notre objectif était l’étude des performances de l’hyperglycémie dans le diagnostic d’IDM en préhospitalier.
Matériel et méthodes
Nous avons mené une étude prospective sur six mois en incluant consécutivement les patients suspects de syndrome coronarien aigu (SCA) pris en charge par le Smur. Le diagnostic d’IDM était validé par le cardiologue ou l’urgentiste après l’admission en structure hospitalière. L’analyse était faite sur l’ensemble de la population puis dans un sous-groupe excluant les patients avec un SCA-ST+.
Résultats
Sur 204 patients, 47 % avaient un IDM. L’hyperglycémie était plus fréquente chez les IDM que chez les non- IDM (50 % vs 28 %, p<0,01). Le risque d’IDM était plus important en cas d’hyperglycémie chez les patients diabétiques [OR=5,41 (IC95 %: 1,41–20,77); p=0,011] et chez les patients non diabétiques [OR =2,37 (IC95 %: 1,19–4,72); p=0,013]. Après exclusion des SCA-ST+, parmi les 141 patients suspects de SCA non ST+, 23 % avaient un IDM. Une association était de nouveau retrouvée. La VPP et la VPN étaient respectivement de 37 % (IC95 %: 24–51 %) et 84 % (IC95 %: 76–91 %).
Conclusion
Cette étude a démontré une association forte entre IDM et hyperglycémie mais une performance diagnostique limitée. En revanche, son intégration dans des scores de probabilité clinique prétest pourrait être intéressante.
Abstract
Objective
The diagnosis of myocardial infarction (MI) is challenging in the pre-hospital setting. Our objective was to determine the predictive value of hyperglycaemia for the diagnosis of MI in the prehospital setting.
Materials and methods
This prospective study was conducted over a six-month period, in which we consecutively enrolled patients with suspected acute coronary syndrome (ACS) who were under the care of the Service mobile d’urgence et de réanimation — SMUR (mobile emergency and resuscitation services). Following admission to a hospital, an emergency physician or cardiologist confirmed the diagnosis of MI. Data analysis was conducted on the general population and on a subgroup that excluded patients who had elevated ST segments.
Results
Of 204 patients, 47% had an MI. Hyperglycaemia was more common in patients with MI than in non-MI patients (50% vs 28%, p < 0.01). The risk of MI was higher in patients with hyperglycaemia and diabetes [odds ratio (OR) = 5.41 (95% confidence interval [CI]: 1.41–20.77), p = 0.011] and in patients without diabetes [OR = 2.37 (95% CI: 1.19–4.72), p = 0.013]. Among the 141 patients without ST elevations, 23% had an MI. Thus, an association was identified between ST elevation and MI. The positive predictive value (PPV) was 37% (95% CI: 24–51%), and the negative predictive value (NPV) was 84% (95% CI: 76–91%).
Conclusion
This study revealed a strong association between MI and hyperglycaemia but with limited diagnostic performance. However, factoring glucose values into the calculation of clinical pre-test probability scores might prove interesting.
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Anezo, M.C., Pradeau, C. & Thicoipe, M. Le dosage de la glycémie capillaire a-t-il un intérêt en préhospitalier pour le diagnostic d’infarctus du myocarde ?. Ann. Fr. Med. Urgence 3, 3–8 (2013). https://doi.org/10.1007/s13341-012-0242-5
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DOI: https://doi.org/10.1007/s13341-012-0242-5