Risk factors, clinical features, management and in-hospital outcome of ST-elevation myocardial infarction in La Réunion

Background A better knowledge of coronary artery disease is needed in regions in epidemiological transition to adapt the strategies of public health screening and prevention and to reduce the burden of cardiovascular diseases. La Reunion is a French overseas island located in the Indian Ocean with a population of 845,000 inhabitants. It is characterized by varied ethnic origins, the high rate of unemployment, coexisting with a high standard health system. Purpose Our aim was to describe the risk factors, characteristics, management and outcome of ST-elevation myocardial infarction (STEMI) in La Reunion. Methods We conducted a retrospective registry that included all MI hospitalized in La Reunion in the four hospitals (1 private and 4 public) within the year 2016. Patients were identified from the hospitalization databases (PMSI-MCO). All medical records of patients hospitalized in CHU de La Reunion were reviewed. Data on risk factors, management and in-hospital mortality of STEMI were extracted and compared to recent published data in continental France (CF) (FAST-MI 2015 registry). Results Three hundred and three STEMI were included. Mean age was 62 ± 14 years, 37% were current smokers, 21% were already taking aspirin and 19% taking statins before MI occurrence. These features were not significantly different to those observed in CF. Conversely, we found a very high proportion of women (36%), of patients with diabetes (34%), hypertension (61%) and patient with history of cardiovascular disease (33%). Overall, the revascularization rate was comparable to CF (80% vs. 82%), with a three-fold higher rate of thrombolysis in La Reunion (20% vs. 6% in CF). In hospital mortality was very high (17%), partly due to the high incidence of cardiogenic shock (17%) and the high prevalence of renal disease (25%). Conclusion Our data confirm the unusual risk factor pattern and the severity of STEMI in La Reunion and stress the need of prospective studies including biological and ethnic data.