Prospective observational study of stroke in Cayenne, Tours and Besançon: The BECATOUR study.

BACKGROUND: Stroke is a major public health issue. Its epidemiology is still poorly known in French Guiana. METHOD: We conducted a prospective observational study including 100 consecutive patients hospitalized for stroke in Cayenne (in French Guiana), and Tours and Besançon (in metropolitan France). We compared their age, medical history, cardiovascular risk factors, pre-admission Rankin score, Glasgow and NIHSS scores, usual treatments, acute phase management, type of stroke, duration of hospitalization, mechanism of stroke according to TOAST classification, NIHSS and Rankin scores at discharge, discharge treatments, and mode of discharge. RESULTS: In French Guiana, the average age of patients was 7years lower (62 y), patients were more frequently affected by hypertension (75%) and diabetes (31%). Lacunar strokes were overrepresented (16.1%), and infarctions of cardioembolic origin were underrepresented (12%). NIHSS entry and Glasgow scores were similar between French Guiana and mainland France. Acute management was different: thrombolysis rate (9.3%) was 3 to 4 times lower, thrombectomy was not available. Fewer patients were transferred to rehabilitation centers and more patients were transferred to home hospitalization. DISCUSSION: In Tours and Besançon, patients eligible for thrombectomy were overrepresented. This bias explains the overrepresentation of more severe infarctions and probably the overrepresentation of strokes of cardioembolic origin. Infarctions of undetermined origin were more numerous in French Guiana because patients were often discharged from hospital with an incomplete cardiological workup. CONCLUSION: Despite some caveats, the profile of patients admitted for stroke in French Guiana is different from mainland France. The establishment of a stroke unit and an information campaign on the symptoms of stroke would allow better management.

The epidemiology of acute coronary syndromes in French Guiana.

BACKGROUND: French Guiana is an overseas territory of France with marked specificities in terms of populations, socioeconomic factors, risk factors, and an access to care. In this context, the objective of the present study was to describe the epidemiology of acute coronary syndromes in French Guiana and to make comparisons with mainland France and neighbouring country. METHODS: The data were obtained from a retrospective descriptive hospital-based cohort conceived to describe the incidence of acute coronary syndromes and their epidemiologic and clinical characteristics. It included patients aged 18 or more hospitalised for a first coronary syndrome in the reference centre for coronary syndromes in Cayenne French Guiana between Jan 1st 2012 and Dec 31st 2014. Overall, 266 patients were analysed. RESULTS: The mean age was 64 years (SD=12.54). A majority of patients were men (sex ratio=1.83). The proportion of patients born in an overseas French territory (44.36%) was similar to that of those born in a foreign country (43.98%), and 11.65% were born in mainland France. Only 59% of patients had regular health insurance. Moreover, 33.21% had universal medical insurance (CMU for those below a minimal income), 4.91% had state insurance (for illegal foreign patients) and 2.64% had no insurance at all. The main risk factors were high blood pressure (73.68%), diabetes (39.85%), hypercholesterolemia (40.23%), and smoking (37.97%). Overall, 82/266 patients developed an ST elevation coronary syndrome (STEMI) and 184/266 had a non-ST elevation coronary syndrome NSTEMI or unstable angina pectoris. Thrombolysis was only performed in 20.73% of patients with STEMI. Mortality at 1 month was 8/82 (9.76%) for STEMI and 2/184 (1.09%) for NSTEMI. CONCLUSIONS: The epidemiologic profile of acute coronary syndromes in French Guiana is different from that of mainland France and Europe to the neighbouring country Brazil. Mortality of STEMI also seems higher than in mainland France, but similar to Brazil. In a context of frequent health inequalities, interventions targeting the major risk factors, notably high blood pressure, obesity and diabetes, have the potential to significantly impact cardiovascular morbidity and mortality.