HAL Id: dumas-00702191
https://dumas.ccsd.cnrs.fr/dumas-00702191
Submitted on 29 May 2012
HAL is a multi-disciplinary open access
archive for the deposit and dissemination of sci-entific research documents, whether they are pub-lished or not. The documents may come from teaching and research institutions in France or abroad, or from public or private research centers.
L’archive ouverte pluridisciplinaire HAL, est destinée au dépôt et à la diffusion de documents scientifiques de niveau recherche, publiés ou non, émanant des établissements d’enseignement et de recherche français ou étrangers, des laboratoires publics ou privés.
Taux d’adhésion aux recommandations de la prise en
charge pré hospitalière des syndromes coronariens aigus
avec élévation du segment ST
Boris Aurié
To cite this version:
Boris Aurié. Taux d’adhésion aux recommandations de la prise en charge pré hospitalière des syn-dromes coronariens aigus avec élévation du segment ST. Médecine humaine et pathologie. 2012. �dumas-00702191�
! "#$%&'($)&!*+(&,-!.+"'$&'! ./0"1)&!2&!3&2&0$#&!2&!4'&#+51&! ! ! /6678!9!:;<:!!! ! ! ! ! ! !!!!!!!!!!!!!!!!!!!!!!!!!!!! #=! ! ! ! !
TAUX D'ADHÉSION AUX RECOMMANDATIONS DANS LA PRISE EN
CHARGE PRÉHOSPITALIÈRE DES SYNDROMES CORONARIENS
AIGUS AVEC ELEVATION DU SEGMENT ST
! ! )-&(&! ,'&(&#)&&!,+"'!1>+5)&#)$+#!2"!2+0)+'/)!&#!3&2&0$#&! ! DIPLÔME D’ETAT ! ! ! ! !"#$%&#%'()*'+"*,-'./012' ! #7!?8!@!*A6BC8D!<EF<!G!3H6IJ8??C8D!! ! )-&(&!(+")&#"&!,"51$K"&3&#)!/!1/!./0"1)&!2&!3&2&0$#&!2&!4'&#+51&L! ! 18!B86MD8MC!:@!NAC!:;<:! ! ' ' 345.67'84'9/0:';<=><!4'34'' ! ,D7OCM86I8!MP!QPDR!9!! ! =?%@'A%'(*"B%--%#*'C*)&D",-%';.0>467140' ! 38NSD8O! ' =@'A%'(*"B%--%#*'EF*)AG'5.6H477<' ' =@'A%'(*"B%--%#*'5,&I%&$'3.648' ' =@'A%'G"I$%#*'3"?,&,J#%'!.5.0:'K3,*%I$%#*'G%'$LM-%N' ' ! !
*La Faculté de Médecine de Grenoble n’entend donner aucune approbation ni improbation aux opinions émises dans les thèses ; ces opinions sont considérées comme propres à leurs auteurs.
'
'
'
! <!
'
'
'
'
'
'
'
'
'
'
'
'
0%?%*I,%?%&$-'
! ! T!N8O!JAD86IO!UV8CDA!8I!4C?S8DIW!JHPD!?8PD!OHPIC86!8I!?8PDO!86XHPDAY8N86IO!ZP[C?O!H6I!OP! N8!MH668D!AB8X!ANHPD!IHPI!AP!?H6Y!M8!N8O!7IPM8O\! ! T!NH6OC8PD!?8!MHXI8PD!2HNC6CZP8!(/%/']W!MCD8XI8PD!M8!IV^O8!JHPD!OA!MCOJH6CSC?CI7W!?A! J8DIC686X8!M8!O8O!D8NADZP8O!8I!?A!QPOI8OO8!M8!O8O!XHDD8XICH6O\! ! T!NAMAN8!?8!JDH_8OO8PD!.DA6`HCO8!0/',&#)$&'W!JD7OCM86I8!MP!QPDR\! ! /Pa!JDH_8OO8PDO!47DA?M!%/#b&))+!8I!%C6X86I!2/#&1W!N8NSD8O!MP!QPDR\! ! T!NH6OC8PD!?8!MHXI8PD!*7DcN8!*"#2W!JHPD!OH6!ACM8!JD7XC8PO8!86!OIAICOICZP8!N7MCXA?8\! ! T!NH6!_D^D8!07MDCXW!I76HD!?RDCZP8!8I!Q8P68!Y86MADN8W!JHPD!O8O!86XHPDAY8N86IO\! ! T!N8O!H6X?8O!M[/?Y7DC8!8I!G!IHPI!?8O!N8NSD8O!M8!?A!_ANC??8!ZPC!J86O86I!ID^O!_HDI!G!NHC!JAD! M8?G!?A!N7MCI8DDA678\! !! :!
Nom Prénom Intitulé de la discipline universitaire
ALBALADEJO Pierre Anesthésiologie-réanimation ARVIEUX-BARTHELEMY Catherine Chirurgie générale
BACONNIER Pierre Biostatiques, informatique médicale et technologies de communication
BAGUET Jean-Philippe Cardiologie BALOSSO Jacques Radiothérapie
BARRET Luc Médecine légale et droit de la santé BAUDAIN Philippe Radiologie et imagerie médicale
BEANI Jean-Claude Dermato-vénéréologie
BENHAMOU Pierre Yves Endocrinologie, diabète et maladies métaboliques BERGER François Biologie cellulaire
BLIN Dominique Chirurgie thoracique et cardio-vasculaire BOLLA Michel Cancérologie; radiothérapie
BONAZ Bruno Gastroentérologie; hépatologie; addictologie BOSSON Jean-Luc Biostatiques, informatique médicale et technologies de
communication BOUGEROL Thierry Psychiatrie d'adultes BRAMBILLA Elisabeth Anatomie et cytologie pathologiques BRAMBILLA Christian Pneumologie
BRICAULT Ivan Radiologie et imagerie médicale BRICHON Pierre-Yves Chirurgie thoracique et cardio-vasculaire
BRIX Muriel Chirurgie maxillo-faciale et stomatologie CAHN Jean-Yves Hématologie
CARPENTIER Françoise Thérapeutique; médecine d'urgence CARPENTIER Patrick Chirurgie vasculaire; médecine vasculaire
CESBRON Jean-Yves Immunologie CHABARDES Stephan Neurochirurgie
CHABRE Olivier Endocrinologie, diabète et maladies métaboliques CHAFFANJON Philippe Anatomie
CHAVANON Olivier Chirurgie thoracique et cardio-vasculaire CHIQUET Christophe Ophtalmologie
CHIROSSEL Jean-Paul Anatomie
CINQUIN Philippe Biostatiques, informatique médicale et technologies de communication
COHEN Olivier Biostatiques, informatique médicale et technologies de communication
COUTURIER Pascal Gériatrie et biologie du vieillissement CRACOWSKI Jean-Luc Pharmacologie fondamentale; pharmacologie clinique
Professeur des Universités - Praticien Hospitalier 2011-2012
! d!
DE GAUDEMARIS Régis Médecine et santé au travail DEBILLON Thierry Pédiatrie
DEMATTEIS Maurice Addictologie
DEMONGEOT Jacques Biostatiques, informatique médicale et technologies de communication
DESCOTES Jean-Luc Urologie
ESTEVE François Biophysique et médecine nucléaire FAGRET Daniel Biophysique et médecine nucléaire FAUCHERON Jean-Luc Chirurgie générale
FERRETTI Gilbert Radiologie et imagerie médicale FEUERSTEIN Claude Physiologie
FONTAINE Eric Nutrition
FRANCOIS Patrice Epidémiologie, économie de la santé et prévention GARBAN Frédéric Hématologie; transfusion
GAUDIN Philippe Rhumatologie
GAVAZZI Gaetan Gériatrie et biologie du vieillissement GAY Emmanuel Neurochirurgie
GRIFFET Jacques Chirurgie infantile HALIMI Serge Nutrition
HOMMEL Marc Neurologie
JOUK Pierre-Simon Génétique JUVIN Robert Rhumatologie KAHANE Philippe Physiologie
KRACK Paul Neurologie
KRAINIK Alexandre Radiologie et imagerie médicale LANTUEJOUL Sylvie Anatomie et cytologie pathologiques
LEBAS Jean-François Biophysique et médecine nucléaire LEBEAU Jacques Chirurgie maxillo-faciale et stomatologie LECCIA Marie-Thérèse Dermato-vénéréologie
LEROUX Dominique Génétique
LEROY Vincent Gastroentérologie; hépatologie; addictologie LETOUBLON Christian Chirurgie générale
LEVY Patrick Physiologie
LUNARDI Joël Biochimie et biologie moléculaire MACHECOURT Jacques Cardiologie
MAGNE Jean-Luc Chirurgie vasculaire MAITRE Anne Médecine et santé au travail MAURIN Max Bactériologie-virologie
MERLOZ Philippe Chirurgie orthopédique et traumatologique
! e!
MORAND Patrice Bactériologie-virologie MORO-SIBILOT Denis Pneumologie
MOUSSEAU Mireille Cancérologie
MOUTET François Chirurgie plastique, reconstructrice et esthétique; brûlogie PALOMBI Olivier Anatomie
PASSAGIA Jean-Guy Anatomie
PAYEN DE LA GARANDERIE Jean-François Anesthésiologie-réanimation PELLOUX Hervé Parasitologie et mycologie
PEPIN Jean-Louis Physiologie
PERENNOU Dominique Médecine physique et de réadaptation PERNOD Gilles Médecine vasculaire PIOLAT Christian Chirurgie infantile
PISON Christophe Pneumologie PLANTAZ Dominique Pédiatrie
POLACK Benoît Hématologie PONS Jean-Claude Gynécologie-obstétrique RAMBEAUD Jean-Jacques Urologie
REYT Emile Oto-rhino-laryngologie RIGHINI Christian Oto-rhino-laryngologie ROMANET Jean-Paul Ophtalmologie
SARAGAGLIA Dominique Chirurgie orthopédique et traumatologique SCHMERBER Sébastien Oto-rhino-laryngologie
SELE Bernard Biologie et médecine du développement et de la reproduction SERGENT Fabrice Gynécologie-obstétrique
SESSA Carmine Chirurgie vasculaire
STAHL Jean-Paul Maladies infectueuses; maladies tropicales STANKE Françoise Pharmacologie fondamentale
TIMSIT Jean-François Réanimation
TONETTI Jérôme Chirurgie orthopédique et traumatologique TOUSSAINT Bertrand Biochimie et biologie moléculaire
VANZETTO Gérald Cardiologie
VUILLEZ Jean-Philippe Biophysique et médecine nucléaire
WEIL Georges Epidémiologie, économie de la santé et prévention ZAOUI Philippe Néphrologie
ZARSKI Jean-Pierre Gastroentérologie; hépatologie; addictologie
' '
'
! @!
1&$*"G#I$,"&' '
28BA6I! ?[V7I7DHY767CI7! M8O! JDAICZP8O! X?C6CZP8O! MA6O! ?A! NA?AMC8! XHDH6ADC8668W! ?8O! OHXC7I7O! OABA6I8O! H6IW! M8JPCO! J?POC8PDO! A6678OW! NCO! 86! _HDN8! M8O!
D^Y?8O! 7MCI78O! OHPO! _HDN8! M8!
D8XHNNA6MAICH6O\! 18PD! D8OJ8XI! 8OI! JDCNHDMCA?! XAD! 8??8O! AN7?CHD86I! MCD8XI8N86I! ?8! JDH6HOICX! 8I! ?A! OPDBC8! MP! JAIC86I\!!
18! '&("'0+'! f'7O8AP! M8O! "DY86X8O! 0HDH6ADC8668O! M8! ?>ADX! A?JC6g! 7MCI8! XVAZP8! A6678! M8O! D8XHNNA6MAICH6O! MA6O! ?A! NA?AMC8! XHDH6ADC8668! ACYP8\' 18! SPI! M8! X8! IDABAC?! A! 7I7! M[7BA?P8D! ?8! IAPa! M8!?8PD!AMV7OCH6!MA6O!?A!JDCO8!86!XVADY8! M8O! OR6MDHN8O! XHDH6ADC86O! ACYPO! AB8X! OPD7?7BAICH6! MP! O8YN86I! ()! f(0/! ()hg! 86!JD7VHOJCIA?C8D\'
'
=)$F*,%A'%$'?F$L"G%-'
!
!08II8! 7IPM8! D7IDHOJ8XICB8! XH6X8D68! M8O! JAIC86IO! BCXICN8! M[P6! C6_ADXIPO! MP! NRHXADM8! f$23g! JDCO! 86! XVADY8! 86! JD7! VHOJCIA?C8D! JAD! ?8! (3"'! M[/668XR\! 1[A6A?RO8! M8O! MHOOC8DO! N7MCXAPa! A! 7I7! JHOOCS?8! YDiX8! AP! D8YCOID8! MP! '&("'0+'W! NCO! 86! J?AX8! M8JPCO! :;;e! A_C6!M[7BA?P8D!?A!JDCO8!86!XVADY8!M8!X8II8! JAIVH?HYC8\! 08! D8YCOID8! 8OI! N867!
XH6_HDN7N86I! G! ?A! M7X?ADAICH6!
M[-8?OC6jC! AB8X! ?[HSI86ICH6! MP! XH6O86I8N86I! 7X?ACD7! M8O! JAIC86IO! ZPC! R! OH6I! C6X?PO\! 18O! D8XHNNA6MAICH6O! D7YCH6A?8O! 7MCI78O! JAD! ?8! D7O8AP! OH6I! D77BA?P78O!8I!NCO8O!G!QHPD!AP!O8C6!M8!OH6! SPD8AP! 86! AXXHDM! 8I! 86! _H6XICH6! M8O! M8D6C^D8O!MH6678O!M8!?A!OXC86X8\!!
!18! JDHIHXH?8! M8! JDCO8! 86! XVADY8! JD7! VHOJCIA?C^D8!M8O!(0/!()h!_ACI!AJJ8?!G!P6! !
'
7)#O' GP)GLF-,"&' )#O' *%I"??)&G)$,"&-' G)&-' A)' (*,-%' %&' IL)*Q%'
(*FL"-(,$)A,M*%'G%-'-R&G*"?%-'I"*"&)*,%&-'),Q#-')S%I'FAFS)$,"&'G#'
-%Q?%&$'!7@'
! ! ! ! ! ! ! 0F-#?F' ! !!!!1A!JDCO8!86!XVADY8!JD7VHOJCIA?C^D8!M8O!OR6MDHN8O!XHDH6ADC86O!ACYPO!AB8X!7?7BAICH6!MP!O8YN86I!()!f(0/! ()hg! _ACI! ?[HSQ8I! M8! J8DJ7IP8??8O! AN7?CHDAICH6O! JAD! ?A! NCO8! 86! J?AX8! M8! D8XHNNA6MAICH6O! M8! SH668! JDAICZP8! X?C6CZP8\! 1[HSQ8XIC_! M8! X8II8! 7IPM8! D7IDHOJ8XICB8! A! 7I7! M[7BA?P8D! ?8! IAPa! M[AMV7OCH6! APa! D8XHNNA6MAICH6O!7MCI78O!JAD!?8!'&("'0+'!f'7O8AP!M8O!"DY86X8O!0HDH6ADC8668O!M8!?[ADX!A?JC6g!MA6O!?A! JDCO8!86!XVADY8!JAD!?8!(3"'!M[/668XR!M8O!(0/!()h\!28!QA6BC8D!:;;E!G!M7X8NSD8!:;<;W!<F;!JAIC86IO!H6I! 7I7! C6X?PO\! :k! 7IAC86I! M7QG! C6X?PO! MA6O! P68! APID8! 7IPM8! f()'&/3g! 8I! H6I! 7I7! A6A?RO7O! O7JAD7N86I\! 18! YDHPJ8! JDC6XCJA?! f6l<@dg! A! JD7O86I7! P6! IAPa! M[AMV7OCH6! M8! m;W<n! f6lE:g\! ,ADNC! ?8O! m<! XAO! M8! 6H6! AMV7OCH6W! E! 6[ABAC86I! JAO! P68! OIDAI7YC8! M8! D8J8D_POCH6! AMAJI78W! :k! 68! D8OJ8XIAC86I! JAO! ?[A6ICXHAYP?A6I! D8XHNNA6M7! 8I! @e! 6[ABAC86I! JAO! P68! IV7DAJ8PICZP8! HJICNA?8! 8I! JD7O86IAC86I! M8O! 8DD8PDO! N7MCXAN86I8PO8O\!1[A6A?RO8!OIAICOICZP8!D8IDHPB8!P68!MC__7D86X8!OCY6C_CXAICB8!86!NCOOCH6O!O8XH6MACD8OW!Ho! ?8O!OHC6O!OH6I!M7SPI7O!MA6O!P6!APID8!VcJCIA?!MP!'&("'0+'\!18!IAPa!M[AMV7OCH6!AP!JDHIHXH?8!AC6OC!ZP8!?8! 6HNSD8! M8! IV7DAJ8PICZP8O! HJICNA?8O! R! 8OI! NHC6O! CNJHDIA6I! fe:W<n! 8I! @;ng! JAD! DAJJHDI! APa! NCOOCH6O! JDCNACD8O! fmmW<n! 8I! mEWmng\! 18! YDHPJ8! ()'&/3! f6l:kg! A! P6! IAPa! M[AMV7OCH6! J?PO! CNJHDIA6I! G! keW<n! f6l:;gW!OA6O!MC__7D86X8!OCY6C_CXAICB8!AB8X!?8!YDHPJ8!JDC6XCJA?\!1[7IPM8!A!NH6ID7!ZP8!d!C6I8DB86ICH6O!OPD!@! D8OJ8XIAC86I! C6I7YDA?8N86I! ?8O! D8XHNNA6MAICH6O\! 1[AN7?CHDAICH6! MP! IAPa! M[AMV7OCH6! JAOO8! JAD! ?[HJICNCOAICH6!M8!?A!MC__POCH6!8I!M8!?A!AJJ?CXAICH6!M8!X8O!D8XHNNA6MAICH6O!AC6OC!ZP8!JAD!?8!Dc?8!8OO86IC8?!M8! ?A!D7YP?AICH6W!ZPC!MHCI!pID8!AP!X86ID8!MP!MCOJHOCIC_!M8!JDCO8!86!XVADY8\!!! m! XVHCa! M8! OIDAI7YC8! M8! D8J8D_POCH6!
fIVDHNSH?RO8! HP! A6YCHJ?AOIC8! JDCNACD8g! 8I! G! P6! XVHCa! M8! IV7DAJ8PICZP8O! G! AJJ?CZP8D! O8?H6! ?8O! XCDXH6OIA6X8O\! 08! JDHIHXH?8!8OI!M7IAC??7!86!A668a8\!
!1>A6A?RO8! XHPBD8! ?[86O8NS?8! M8! ?A! J7DCHM8! A??A6I! M8! QA6BC8D! :;;E! G!! M7X8NSD8!:;<;\!2PDA6I!X8II8!J7DCHM8!?8!! (3"'! M[/668XR! A! JADICXCJ7! G! P68! D8XV8DXV8! X?C6CZP8W! ?[7IPM8! ()'&/3! f()DAI8YCX! '8J8D_POCH6! &AD?R! /_I8D! 3RHXADMCA?! $6_ADXICH6g! ZPC! MHCI!
XHNJAD8DW! AJD^O! O7?8XICH6! JAD!
DA6MHNCOAICH6W! ?A! IVDHNSH?RO8! J?PO! A6YCHJ?AOIC8! MC__7D78! G! ?[A6YCHJ?AOIC8! JDCNACD8!O8P?8\!
!18O!XDCI^D8O!M[C6X?POCH6!D8I86PO!OH6I!?8O! JAIC86IO! M8! J?PO! M8! <F! A6O! ZPC! JD7O86I86I! P6! (0/! ()h! M8! NHC6O! M8! MHPq8! V8PD8OW! MCAY6HOICZP7! 86! JD7! VHOJCIA?C8D! JAD! ?A! ORNJIHNAIH?HYC8! X?C6CZP8! AOOHXC78! G! P6! &04! IRJCZP8\! 18O! XDCI^D8O!M8!6H6!C6X?POCH6!XH6X8D686I!?8O! JAIC86IO! NC68PDOW! X8Pa! JD7O86IA6I! P6! (0/! ()h! 7BH?PA6I! M8JPCO! J?PO! M8! MHPq8! V8PD8O!AC6OC!ZP8!X8Pa!Ho!8aCOI8!P6!MHPI8! MCAY6HOICX!?HDO!M8!?A!JDCO8!86!XVADY8!JD7! VHOJCIA?C^D8\!
!#HPO! ABH6O! 7BA?P7! ?8! O8a8! MP! JAIC86IW! OH6!iY8!8I!OH6!JHCMOW!?[7ZPCJ8!M8!JDCO8!86! XVADY8!fJDCNACD8!HP!O8XH6MACD8gW!?[V8PD8! M8! M7SPI! M8! ?A! MHP?8PDW! ?8! M7?AC! JHDI8! G! JHDI8! fM7?AC! 86ID8! ?8! MCAY6HOICX! JAD! ?8! N7M8XC6! JHPBA6I! IVDHNSH?RO8D! 8I! ?[ADDCB78! M8BA6I! ?A! OA??8! M8! XADMCH?HYC8! C6I8DB86ICH668??8gW! ?8! NHN86I! M8! ?A! QHPD678! fQHPDr6PCIgW! ?A! JD7O86X8! M8! OCY68O! M8! YDABCI7! fI86OCH6! ADI7DC8??8! OROIH?CZP8! C6_7DC8PD8! G! <;;NN-Y! 8I! _D7ZP86X8! XADMCAZP8! OPJ7DC8PD8! G! <;;! JAD! NC6PI8gW! ?8! IRJ8! M8! D8J8D_POCH6! AMHJI7! 8I! ?A! IV7DAJ8PICZP8! AJJ?CZP78! fA6ICAYD7YA6IOW! A6ICXHAYP?A6IOW! _CSDC6Hs! ?RICZP8OW! A6IA?YCZP8OW! S7IAS?HZPA6IO! 8I! M7DCB7O!6CID7Og\!
!18! XDCI^D8! M8! QPY8N86I! JDC6XCJA?! 8OI! ?8! IAPa! M[AMV7OCH6! APa! D8XHNNA6MAICH6O! 7MCI78O! JAD! ?8! '&("'0+'! JHPD! ?A! JDCO8! 86!XVADY8!M[P6!(0/!()h!M8!NHC6O!M8!<:! V8PD8OW! 86! AXXHDM! AB8X! ?8O! NHMA?CI7O! M8! ?[7IPM8!XH6XHNCIA6I8!()'&/3\!!
!18O! BADCAS?8O! ZPA6ICIAICB8O! OH6I! 8aJDCN78O! G! ?>ACM8! M8! ?8PDO! NHR8668OW! 7XADIsIRJ8! 8I! N7MCA68! IA6MCO! ZP8! ?8O! BADCAS?8O! ZPA?CIAICB8O! OH6I! 8aJDCN78O! G! ?>ACM8! M8! ?8PDO! _D7ZP86X8O! 8I! M8! ?8PDO! JHPDX86IAY8O\! 18O! XHNJADACOH6O! M8! JHPDX86IAY8O!OH6I!8__8XIP78O!JAD!?8!I8OI! MP!0VC:\!18!O8PC?!M8!OCY6C_CXAICBCI7!D8I86P! 8OI!_Ca7!G!@!n\! ' 0F-#A$)$-' !
!,86MA6I! ?A! J7DCHM8! M[7IPM8W! <F;! JAIC86IO! H6I! 7I7! C6X?PO\! <@d! M[86ID8! 8Pa!! 6[H6I! JADICXCJ7! G! APXP68! 7IPM8! 8I! XHNJHO86I! ?8! YDHPJ8! JDC6XCJA?\! 18O! :k! JAIC86IO!C6X?PO!MA6O!?[7IPM8!()'&/3!H6I! 7I7! A6A?RO7O! G! JADI! AB8X! ?8O! NpN8O! XDCI^D8O!ZP8!MA6O!?8!YDHPJ8!JDC6XCJA?\! !2A6O! ?8! YDHPJ8! JDC6XCJA?W! Fd! JAIC86IO! H6I! S767_CXC7! M[P6! IDACI8N86I! JAD! A6YCHJ?AOIC8! JDCNACD8! 8I! ?8O! k;! APID8O! JAD! IVDHNSH?RO8\! 18O! D8XHNNA6MAICH6O! H6I! 7I7! D8OJ8XI78O! XV8q! E:! JAIC86IO! OHCI! P6!IAPa!M[AMV7OCH6!M8!m;W<n\!
!,ADNC! ?8O! m<! JDCO8O! 86! XVADY8! 6[ARA6I! JAO! OPCBC! ?8! JDHIHXH?8! MP! '&("'0+'W! E! OIDAI7YC8O! 6[7IAC86I! JAO! AMAJI78O! f:! OPD! ?[V8PD8! M8! M7SPI! M8! ?A! MHP?8PDW! d! OPD! ?8! M7?AC! JHDI8! G! JHDI8! 8I! e! OPD! ?[iY8! MP! JAIC86Ig! OHCI! <eWkn\! 18O! APID8O! XAPO8O! M[7XADI! APa! D8XHNNA6MAICH6O! JHDI86I! 8OO86IC8??8N86I!OPD!?A!IV7DAJ8PICZP8\!!!!!!!!!!!!!!!!!!!! !!!!!!!!!!!! )V7DAJ8PICZP8!AMNC6COID78! ! ! "#$! "$%! &$! %&! '(! '(! "&! "(! )! *! %! #! "*! "! (! $(! &(! %(! )(! "((! "$(! "&(! "%(! ")(! !"#$%$&'( )*+#$,+-%'*(( #%!".-%'*( !/01-2$$34$$$5( 6'#!%$&'( 7$8!*$%.,$&'( '&+9!#!%$&'( :'&'):'#*!"'( !"#$%&'( )*+,-.%/'( )-*.,-.%/'( !$0..0-1( 21('345.( ! ! !!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!)AS?8AP!<! !
! k! %C6YI!O8JI!M8!X8O!JDCO8O!86!XVADY8!feeng!
H6I! P68! IV7DAJ8PICZP8! A6ICXHAYP?A6I8! XVHCOC8! ZPC! 6[7IACI! JAO! AMAJI78! G! ?A! OIDAI7YC8! M8! D8J8D_POCH6! 8I! @e! JDCO8O! 86! XVADY8! fFFW@ng! Ho! ?A! IV7DAJ8PICZP8! 6[7IACI! JAO! HJICNA?8W! XHNJD86A6I! M8O! 8DD8PDO!N7MCXAN86I8PO8O!fIAS?8AP!<g\!! 1A! NHDJVC68! A! 7I7! PIC?CO78! XV8q! k@! JAIC86IO! MP! YDHPJ8! JDC6XCJA?! feEngW! ?A! IDC6CIDC68!XV8q!<E!JAIC86IO!f<:Weng!8I!?A! I76HDNC68!XV8q!<:!JAIC86IO!fkWFng\! !1[A6A?RO8!OIAICOICZP8W!XHNJADA6I!?8!OHPO! YDHPJ8! A6YCHJ?AOIC8! AP! OHPO! YDHPJ8! IVDHNSH?RO8! MA6O! ?8! YDHPJ8! JDC6XCJA?W! 68! D8IDHPB8! JAO! M8! MC__7D86X8! OCY6Cs! _CXAICB8! 86ID8! ?8O! IAPa! M[AMV7OCH6! APa! D8XHNNA6MAICH6O! fJl;We;Fg\! &??8! 68! D8IDHPB8! JAO! 6H6! J?PO! M8! MC__7D86X8! OCY6C_CXAICB8! XH6X8D6A6I! ?8! D8OJ8XI! M8! ?A! OIDAI7YC8! fJl;Wdemg! HP! X8?PC! M8! ?A! IV7DAJ8PICZP8!G!AJJ?CZP8D!fJl;W:dkg\! !&6! D8BA6XV8W! MA6O! ?8! OHPO! YDHPJ8! M8O! JAIC86IO! IDACI7O! JAD! A6YCHJ?AOIC8W! ?8O! IV7DAJ8PICZP8O! A6ICXHAYP?A6I8O! 6H6! AMAJI78O! G! ?A! OIDAI7YC8! OH6I! M8! NA6C^D8! OCY6C_CXAICB8! J?PO! _D7ZP86I8! G! :@Wdn! XH6ID8! FWmn! MA6O! ?8! OHPO! YDHPJ8! M8O! JAIC86IO! IDACI7O! JAD! IVDHNSH?RO8! fJl;W;<;g\!
!1[A6A?RO8! OIAICOICZP8! OIDAIC_C78! 68! D8IDHPB8! JAO! M[C6_?P86X8! OPD! ?8! IAPa! M[AMV7OCH6! APa! D8XHNNA6MAICH6O! 86! _H6XICH6!MP!O8a8!MP!JAIC86I!fJl;Wk;@g!HP! MP! NHN86I! fQHPDr6PCIg! M8O! JDCO8O! 86! XVADY8! fJl;W:<;g\! 08O! M8Pa! JADAN^ID8O! 68! JD7O86I86I! JAO! 6H6! J?PO! M[C6_?P86X8! OPD! ?8! D8OJ8XI! M8! ?A! OIDAI7YC8! G! AMHJI8D! fJl;We@egW! 6C! OPD! ?A! IV7DAJ8PICZP8! G! OPCBD8! fJl;Wm:Eg! HP! OPD! ?8O! 8DD8PDO! N7MCXAN86I8PO8O!XHNNCO8O!fJl;WmEEg\! !,AD! XH6ID8W! AP! XHPDO! M8O! NCOOCH6O! O8XH6MACD8O!MP!(3"'!/668XC86!fIAS?8AP! :gW! ?HDOZP8! ?8O! JDCO8O! 86! XVADY8! OH6I! M7SPI78O! MA6O! P6! APID8! VcJCIA?! MP! '&("'0+'W! ?8! IAPa! M[AMV7OCH6! APa! D8XHNNA6MAICH6O! 8OI! OCY6C_CXAICB8N86I! C6_7DC8PD! G! e:W<n! XH6ID8! mmW<n! fJl;W;<dg! 8I! ?8O! IV7DAJ8PICZP8O! HJICNA?8O! OH6I! NHC6O! 6HNSD8PO8O! AB8X! P6! IAPa! M[8DD8PDO! N7MCXAN86I8PO8O! OCY6C_CXAICB8N86I! J?PO! CNJHDIA6I! G! @;n! XH6ID8!d;Wen!fJl;W;ddg\!! ! ! !!!!3COOCH6O!!!!!!! !!!,DCNACD8O! !!3COOCH6O! O8XH6MACD8O! $6I8DB86ICH6O! <<@! dF! /6YCHJ?AOIC8O!JDCNACD8O! kd! <;! )VDHNSH?RO8O! e:! :F! (IDAI7YC8O!D8OJ8XI78O! #H6!D8OJ8XI78O! <;F!r!EeWFn! !!!!!m!r!@W:n! d@!r!FmWFn! !!d!r!<dW:n! )V!/6ICXHAY<!AMAJI78O! #H6!/MAJI78O! !!Em!r!FdW@n! !!<E!r!<mW@n! d;!r!kFWEn! !!F!r!:<W<n! 7LF*)(%#$,J#%-'"($,?)A%-' 6"&'"($,?)A%-T' ''UV'W'XYZX[' ''\]'W'\VZ^[' _Y'W']V[' _Y'W']V[' .GLF-,"&-')#'(*"$"I"A%T' !!`X'W'XXZ_[' _X'W'^TZ_[' <!)V7DAJ8PICZP8O!A6ICXHAYP?A6I8O!:!2C__7D86X8O!OCY6C_CXAICB8O! !!!!!!!!!!)AS?8AP!:! ! !
!2A6O! ?8! YDHPJ8! ()'&/3! f6l:kgW! <@! JAIC86IO! H6I! 7I7! IDACI7O! JAD! A6YCHJ?AOIC8! JDCNACD8! 8I! <:! APID8O! JAD! IVDHNSH?RO8\! 18! JDHIHXH?8! A! 7I7! D8OJ8XI7! XV8q! :;! M[86ID8!8PaW!OHCI!P6!IAPa!M[AMV7OCH6!APa! D8XHNNA6MAICH6O! M8! keW<n\! (Ca! M8O! k! JDCO8O! 86! XVADY8! 6[ARA6I! JAO! AMV7D7! AP! JDHIHXH?8W! H6I! P68! IV7DAJ8PICZP8! A6ICXHAYP?A6I8!ZPC!6[8OI!JAO!AMAJI78!G!?A! OIDAI7YC8! M8! D8J8D_POCH6\! )DHCO! 68! OH6I! JAO!HJICNA?8O!8I!XHNJHDI86I!P68!8DD8PD! N7MCXAN86I8PO8! fP6! OPDMHOAY8! 8I! P6! HPS?C! M8! X?HJCMHYD8?W! P6! HPS?C! M[A6ICs 4J$$Sr$$$Ag\!!
!1[A6A?RO8!OIAICOICZP8!68!D8IDHPB8!JAO!M8! MC__7D86X8! OCY6C_CXAICB8! AB8X! ?8! IAPa! M[AMV7OCH6! MP! YDHPJ8! JDC6XCJA?! fJl;W;@mgW! 6C! 86ID8! ?8O! OHPO! YDHPJ8O! IVDHNSH?RO8! 8I! A6YCHJ?AOIC8! JDCNACD8\! 1[A6A?RO8! OIDAIC_C78! 68! D8IDHPB8! JAO! 6H6! J?PO! M[C6_?P86X8! 86! _H6XICH6! MP! O8a8! MP! JAIC86I! HP! MP! NHN86I! fQHPDr6PCIg! M8O! C6I8DB86ICH6O\!
!
3,-I#--,"&'
!
!18O!YPCM8?C68O!M8!JDAICZP8!X?C6CZP8!OH6I! M8O! D8XHNNA6MAICH6O! _ACI8O! JHPD! ?8O! N7M8XC6O! XH6X8D6A6I! ?A! JDCO8! 86! XVADY8! M8! JAIC86IO! MA6O! M8O! XH6MCICH6O! OJ7XC_CZP8O\! $?O! OH6I! SAO7O! OPD! ?A! N8C??8PD8! JD8PB8! MCOJH6CS?8! IA6I! AP! 6CB8AP! M8! ?A! D8XV8DXV8! ZP8! M8! ?>8aJ7DC86X8! JDAICZP8\! 18PD! POAY8! A! 7I7! M7XDCI! APa! tIAIOs"6CO! XHNN8! A! u!68v! D8A?CIR! C6! N8MCXC68!w! 8I! O>8OI! M7B8?HJJ7! MA6O! M8! 6HNSD8Pa! JARO! XHNN8! ?A! .DA6X8<\!
! F! 08O! D8XHNNA6MAICH6OW! 7?ASHD78O! JHPD!
?8O! X?C6CXC86O! MA6O! ?8! SPI! M>AN7?CHD8D! ?A! ZPA?CI7! M8O! OHC6O! 8I! ?8! JDH6HOICX! M8O! JAIC86IO:W! H6I! 7I7! M7B8?HJJ78O! 6H6!
O8P?8N86I!AP!6CB8AP!6AICH6A?!NACO!APOOC! G! ?>7XV8??8! M8O! D7O8APa! M8! OHC6O\! 1A! JAIVH?HYC8! XHDH6ACD8! A! 7I7! AC6OC! ?A! JD8NC^D8! JAIVH?HYC8! ACYPx! G! pID8! 86XAMD78! JAD! M8O! D8XHNNA6MAICH6O! 86! N7M8XC68!M>PDY86X8!MA6O!6HID8!D7O8AP\! +D!?[AN7?CHDAICH6!MP!IAPa!M[AMV7OCH6!M8O! X?C6CXC86O!APa!D8XHNNA6MAICH6O!MA6O!?8O! OR6MDHN8O! XHDH6ADC86O! ACYPO! 8OI! AOOHXC78!G!P68!D7MPXICH6!M8!?A!NHDIA?CI7! M8O!JAIC86IO\!1>7IPM8!M8!YDA6M8!ANJ?8PD! M8!,8I8DOH6!&2!86!:;;mW!C6X?PA6I!me!kk@! JAIC86IO! OPD! d@;! X86ID8O! VHOJCIA?C8DOW! NH6ID8! ZP[P68! AN7?CHDAICH6! MP! IAPa! M[AMV7OCH6! M8! <;n! D7MPCI! M8! <;n! ?A! NHDIA?CI7!M8O!JAIC86IOd\!!
1[A6A?RO8! D7IDHOJ8XICB8! M8O! JDCO8O! 86! XVADY8! M8O! (0/! ()h! D8IDHPB8! P6! IAPa! M[AMV7OCH6! APa! D8XHNNA6MAICH6O! M8! m;nW!OHCI!?[7ZPCBA?86I!M8!d!C6I8DB86ICH6O! OPD! @! ZPC! H6I! D8OJ8XI7! 86IC^D8N86I! ?8! JDHIHXH?8! 7MCI7! JAD! ?8! '&("'0+'\! (C! X8! D8OJ8XI! M8O! D8XHNNA6MAICH6O! 6>8OI! JAO! HJICNA?W! C?! O8NS?8! IHPI8_HCO! OAICO_ACOA6I! ZPA6M!?A!?CII7DAIPD8!6HPO!NH6ID8!ZP8!?8O! D8XHNNA6MAICH6O! OXC86IC_CZP8O! 68! OH6I! NCO8O! 86! yPBD8! ZP8! XV8q! ?A! NHCIC7! M8O! NA?AM8Oe\!
2C__7D86I8O! DACOH6O! 8aJ?CZP86I! ZP8! X8! IAPa! 68! J8PI! AII8C6MD8! <;;n\! 18O! JD7_7D86X8O!M8O!JAIC86IO!J8PB86I!68!JAO! ?8O! XH6MPCD8! G! OPCBD8! ?8O! C6_HDNAICH6O! 7X?ACD78O! 8I! ?8O! M7XCOCH6O! 86XHD8! IDHJ! OHPB86I! JDCO8O! JAD! ?8O! N7M8XC6O! OA6O! ?A! JADICXCJAICH6! M8O! NA?AM8O! JAD! 8a8NJ?8\! 28!NpN8!IHPO!?8O!N7M8XC6O!68!OHCY686I! JAO! MA6O! P68! JAIVH?HYC8! MH6678! P6! 6HNSD8! OP__COA6I! M8! NA?AM8O! JHPD! ZP>P68! 7BA?PAICH6! XHDD8XI8! M8! ?8PD! J8D_HDNA6X8!JPCOO8!pID8!D7A?CO78\!
18! Dc?8! M8! 6HID8! D7O8AP! D7YCH6A?! '&("'0+'! 8OI! JADICXP?C^D8N86I! CNJHDIA6I! JHPD! APYN86I8D! ?>AMV7OCH6! M8O! N7M8XC6O! APa! D8XHNNA6MAICH6O\! 3pN8! O>C?! 8aCOI8! P68! C68DIC8! G! IHPI! XVA6Y8N86I!M>AIICIPM8W!?8!D7O8AP!J8DN8I! P68! 68II8! AN7?CHDAICH6! M8! ?A! JDAICZP8W! YDiX8! G! OH6! D8YCOID8\! 18O! X?C6CXC86O! H6I!
S8APXHPJ! J?PO! XH6_CA6X8! 86! M8O! ?8AM8DO! ?HXAPa! ZPCW! O>C?O! H6I! JADICXCJ7! G! ?>7?ASHDAICH6! M>P68! D8XHNNA6MAICH6W! 86! D86_HDX86I!?A!XD7MCSC?CI7@\
2A6O! ?A! JAIVH?HYC8! XHDH6ACD8! ACYPxW! ?8! XVHCa! M8! ?A! OIDAI7YC8! M8! D8J8D_POCH6! ! G! 86YAY8D! fA6YCHJ?AOIC8! JDCNACD8! HP! IVDHNSH?RO8g! 8OI! JDCNHDMCA?! XAD! C?! 86YAY8! ?8! JDH6HOICX! MP! JAIC86I! 8I! ?A! IV7DAJ8PICZP8!AOOHXC78!ZPC!86!M7XHP?8\!!!!! 1A! D8BP8! M8! X8O! C6I8DB86ICH6O! 6HPO! NH6ID8! ZP8! ?8O! OIDAI7YC8O! 6[ARA6I! JAO! D8OJ8XI7!?8!JDHIHXH?8!D8OI86I!NADYC6A?8O! fE! C6I8DB86ICH6O! OPD! ! <@dg\! 1A! J?PJADI! M8O! 7XADIO! AP! JDHIHXH?8! XH6X8D686I! ?A! IV7DAJ8PICZP8! AMNC6COID78\! 18O! D8XHNs NA6MAICH6O! JD7XH6CO86I! ?[8NJ?HC! M[P68! -5,3! MA6O! ?8! XAO! M[P68! IVDHNSH?RO8m!!!
8I!M8!?[V7JADC68!OHMCZP8!HP!NC8PaW!M8!?A! SCBA?CDPMC68k! OC! P68! A6YCHJ?AOIC8!
JDCNACD8! 8OI! 86BCOAY78\! 08I! 7XADI! 8OI! D8IDHPB7!MA6O!JD^O!M8!?A!NHCIC7!M8O!!XAO! M8! 6H6! AMV7OCH6W! AB8X! P68! JD7s JH6M7DA6X8! JHPD! ?8! OHPO! YDHPJ8! A6YCHJ?AOIC8!JDCNACD8\!+6!J8PI!OPJJHO8D! ZP8!X8?A!8OI!Mz!AP!_ACI!ZP8!?[76HaAJADC68! 8OI! J?PO! OCNJ?8! M[PIC?COAICH6! ZP8! ?[V7JADC68! OHMCZP8! HP! ?A! SCBA?CDPMC68W! ZPC! 67X8OOCI86I! M[pID8! AMNC6COID78O! 86! C6IDAB8C68PO8!JAD!O8DC6YP8!7?8XIDCZP8\! ,D^O!M8!68P_!XAO!OPD!MCa!M8!6H6!AMV7OCH6! AP! JDHIHXH?8! OH6I! MPO! G! ?A! JD7O86X8! M[P68! 8DD8PD! N7MCXAN86I8PO8! MA6O! ?A! IV7DAJ8PICZP8! AJJ?CZP78\! 1A! NAQHDCI7! fk;ng! XH6X8D68! M8O! 7XADIO! MA6O! ?8! MHOAY8! M8O! N7MCXAN86IO! AMNC6COID7O! MH6I!?[CNJAXI!X?C6CZP8!8OI!_ACS?8F\!1[HPS?C!
M8!?[POAY8!JD7XHX8!M[A6ICs4J$$Sr$$$A!MA6O! ?8O!A6YCHJ?AOIC8O!JDCNACD8OEW<;!8I!M8!X8?PC!
MP! X?HJCMHYD8?<<W<:! H6I! JP! ABHCD! P6!
CNJAXI!X?C6CZP8!J?PO!CNJHDIA6I\!
!!1A!_D7ZP86X8!M[C6I8DB86ICH6!NHC6MD8!8I! ?[7?HCY68N86I! MP! X86ID8! MP! '&("'0+'! J8PB86I! 86! JADIC8! 8aJ?CZP8D! ?8! IAPa! M[AMV7OCH6! AP! JDHIHXH?8! 8I! ?8! 6HNSD8!!! M8! IV7DAJ8PICZP8O! HJICNA?8O! NHC6O! CNJHDIA6IO! 86! NCOOCH6O! O8XH6MACD8O! ?HDOZP8! ?8O! JDCO8O! 86! XVADY8! OH6I! M7SPI78O!JAD!P6!APID8!VcJCIA?!MP!D7O8AP\!!!! !1[A6A?RO8!O7JAD78!MP!YDHPJ8!M8!JAIC86IO! C6X?PO! MA6O! ?[7IPM8! ()'&/3! D7B^?8! P6! IAPa! M[AMV7OCH6! AP! JDHIHXH?8! M8! ken!
! E! N8C??8PD! ZP8! X8?PC! MP! YDHPJ8! JDC6XCJA?!
AB8X! <en! M[AMV7OCH6! OPJJ?7N86IACD8W! ?[A6A?RO8! OIAICOICZP8! 68! D8IDHPB8! JHPDIA6I! JAO! M8! MC__7D86X8! OCY6C_CXAICB8\! 08! D7OP?IAI! A! JP! pID8! _ABHDCO7! JAD! ?A! JDHOJ8XICH6! M8! X8II8! 7IPM8! _ACI8! 8aX?POCB8N86I! 86! NCOOCH6! JDCNACD8\! $?! A! JP!?[pID8!7YA?8N86I!JAD!?8!JDHIHXH?8!ZPC! XVHCOC! ?A! OIDAI7YC8! 8I! JAD! ?8! _ACI! ZP[P68! 7IPM8! 86! XHPDO! C6XCI8! 86! Y767DA?! ?8O! JDAICXC86O! G! OPCBD8! M8! _A`H6! J?PO! DCYHPD8PO8!?8!JDHIHXH?8\!
!,?POC8PDO! ?CNCI8O! H6I! 7I7! D8IDHPB78O! MA6O! X8II8! 7IPM8\! #HID8! A6A?RO8! 6>A! 7IPMC7! ZP8! ?[7ZPCJ8! (3"'! M>/668XR! 8I! M8BDACI!pID8!7I86MP8!86!NP?ICX86IDCZP8!G! ?>86O8NS?8! M8O! VcJCIAPa! MP! '&("'0+'\! 28! J?POW! ?8! XADAXI^D8! D7IDHOJ8XIC_! M8! ?[A6A?RO8! 8I! ?8! _ACI! ZP[P68! JADIC8! M8O! JAIC86IO!7IAC86I!C6X?PO!MA6O!P68!7IPM8!86! XHPDO!86!D7MPCI!OA!JPCOOA6X8\!
!
;"&IA#-,"&'
!
!!1A! JDCO8! 86! XVADY8! M[P6! $6_ADXIPO! MP! 3RHXADM8! ACYP! 8OI! P6! AXI8! D8?AICB8N86I! _D7ZP86I!Ho!?8!JDH6HOICX!BCIA?!8OI!NCO!86! Q8P!8I!Ho!?8!I8NJO!M8!JDCO8!86!XVADY8!8OI! XDPXCA?! JHPD! ?8! M8B86CD! MP! JAIC86I\! 18!
!"#$!%&!! 7MCI8! M8O! D8XHNNA6MAICH6O!
A66P8??8O!JHPD!?A!JDCO8!86!XVADY8!M8!X8O! OR6MDHN8O! XHDH6ACD8O! ACYPO\! 08O! D8XHNNA6MAICH6O! BCO86I! G! ACM8D! ?8O! N7M8XC6O! JHPD! JDHJHO8D! P6! IDACI8N86I! HJICNA?! APa! JAIC86IO\! 08J86MA6I! ?8O! XDCI^D8O!ZPC!M7_C6COO86I!X8II8!OIDAI7YC8!M8! JDCO8! 86! XVADY8! OH6I! 6HNSD8Pa! 8I!
D7YP?C^D8N86I! M8O! 6HPB8API7O!
JVADNAX8PICZP8O! NHMC_C86I! ?8O! IV7DAs! J8PICZP8O!X?AOOCZP8N86I!JDHJHO78O\!08O! OCIPAICH6O!HS?CY86I!?8!JDAICXC86!G!JD86MD8! M8O! M7XCOCH6O! OHPB86I! XHNJ?8a8O! MA6O! P6! ?AJO! M8! I8NJO! D7MPCIW! G! ?>HDCYC68! M>7XADIO! APa! JDHIHXH?8O\! 08II8! 7IPM8! D7IDHOJ8XICB8! _ACI8! AP! (3"'! M>/668XR! ZPC! OPCI! ?8O! D8XHNNA6MAICH6O! MP!
!"#$!%&!! NH6ID8! ZP>C?! AMV^D8! G! X8O!
D8XHNNA6MAICH6O!MA6O!m;n!M8O!XAO\! !!18O!XAPO8O!M8!6H6sD8OJ8XI!AP!JDHIHXH?8! XH6X8D686I! ?A! OIDAI7YC8! M8! D8J8D_POCH6! XVHCOC8! MA6O! E! M8O! m<! 7XADIO! XH6OIAI7O!
Ho!P68!IV7DAJ8PICZP8!6[8OI!JAO!HJICNA?8! MA6O!FFW@n!M8O!XAO\!!
#C! ?8! O8a8! MP! JAIC86IW! 6C! ?[VHDACD8! M[C6I8DB86ICH6! fQHPDr6PCIg! 6>C6_?P86X8! ?>ASO86X8! M>AMV7OCH6! APa! D8XHNs! NA6MAICH6O\! &6! D8BA6XV8! X>8OI! AP! XHPDO! M8O! NCOOCH6O! O8XH6MACD8O! MP! (3"'W! ?HDOZP8! ?8O! IV7DAJ8PICZP8O! H6I! 7I7! M7SPI78O! MA6O! P6! APID8! VcJCIA?! MP! '&("'0+'!ZP8!?8O!7XADIO!OH6I!D8IDHPB7O! M8!_A`H6!OCY6C_CXAICB8\!
(8P?O! ?8O! JAIC86IO! C6X?PO! MA6O! P6! JDHIHXH?8! M8! D8XV8DXV8W! H6I! P6! IAPa! M>AMV7OCH6!G!?A!JDHX7MPD8!SC86!N8C??8PD\! !!/N7?CHD8D! ?8! D8OJ8XI! M8O! D8XHNNA6s! MAICH6O! ! J8DN8I! M8! D7MPCD8! ?A! NHDIA?CI7! M8O! JAIC86IO! ZPC! H6I! P6! OR6MDHN8! XHDH6ADC86! ACYP\! $?! _API! JDHSAS?8N86I! HJICNCO8D!?A!MC__POCH6!8I!?>AJJ?CXAICH6!M8O! D8XHNNA6MAICH6O! AP! (3"'! M>/668XR\! 18! Dc?8! M8! ?A! D7YP?AICH6! 8OI! 8OO86IC8?W! APIA6I! JHPD! AXXHNJAY68D! ?8O! M7XCOCH6O! IV7DAJ8PICZP8O! 86! JDCNACD8! ZP8! JHPD! AN7?CHD8D!?8O!OIDAI7YC8O!NCO8O!86!yPBD8O! JAD! M>APID8O! X86ID8O! VHOJCIA?C8DO! ZPC! OH??CXCI86I! ?8! (3"'! JHPD! DAN868D! ?8O! $23! OPD! ?8! X86ID8! M8! XADMCH?HYC8! C6I8DB86ICH668??8!M>/668XR\! ! 0FBF*%&I%-' ! <\! {HH?_! (-\! ,DAXICX8! YPCM8?C68O!9! /! 68v! D8A?CIR!C6!N8MCXC68\!$\!'8X86I!M8B8?HJN86IO\! /DXV!$6I8D6!38M!<EE;|!<@;9<F<<sF! !
:\! {C?OH6! 30W! -ARvADM! '(W! )P6CO! ('W! 5AOO! &5W! 4PRAII! 4\! "O8DO>! YPCM8O! IH! IV8! N8MCXA?! ?CI8DAIPD8\! %$$$\! -Hv! IH! PO8! X?C6CXA?! JDAXICX8! YPCM8?C68O\! 5\! vVAI! AD8! IV8! D8XHNs N86MAICH6O!A6M!vC??!IV8R!V8?J!RHP!C6!XADC6Y! _HD! RHPD! JAIC86IO!}! )V8! &BCM86X8sSAO8M! N8MCXC68! vHDjC6Y! YDHPJ\! */3/! <EE@|! :ke9<md;s:!
!
d\!,8I8DOH6!&2W!3)!'H8!3]W!3P?YP6M!1!8I!A?\! /OOHXCAICH6! S8Iv886! VHOJCIA?! JDHX8OO! J8D_HDNA6X8! A6M! HPIXHN8O! ANH6Y! JAIC86IO! vCIV! AXPI8! XHDH6ADR! OR6MDHN8O\! */3/W! :;;mW!:E@!f<mg9<E<:s:;\!
!
e\! 3X4?R66! &/\! 8I! A?\! )V8! ZPA?CIR! H_! V8A?IV! XAD8!M8?CB8D8M!IH!AMP?IO!C6!IV8!"6CI8M!(IAI8O\! #!&6Y?!*!38M!:;;d!|!deF9!:md@s:me@!
! <;!
@\! 2HPNCI! 4W! 4AII8??ADC! 3W! 4DCNOVAv! *W! +>5DC86! 3/\! 1HXA?! HJC6CH6! ?8AM8DO!9! &__8XIO! H6! JDH_8OOCH6A?! JDAXICX8! A6M! V8A?IV! XAD8! HPIXHN8O\! 0HXVDA68! 2AIASAO8! (ROI! '8B! :;;k902;;;<:@\!
!
m\! /6INA6! &3W! 3HDDHv! 2/W! 3X0AS8! 0-W! 8I! A?\! &6HaAJADC6! B8DOPO! P6_DAXICH6AI8M! V8JADC6! vCIV! _CSDC6H?ROCO! _HD! ()s8?8BAICH6! NRHXADMCA?!C6_ADXICH6\!&~)'/0)s)$3$!:@!#\! &6Y?!*!38M!:;;m!/JD!m|!d@ef<eg9<ekksFF\! !
k\!(IH68! 4{W! 3X1APDC6! 5)W! 0Ha! 2/! 8I! XH??\! 5CBA?CDPMC6!_HD!JAIC86IO!vCIV!AXPI8!XHDH6ADR! OR6MDHN8\! #! &6Y?! *! 38M! :;;m|! d@@9::;ds ::<m!
!
F\!.A6CjHO! *W!(IAJC6OjC! 0W!UHH! (W!UPXV8D! #W!
)OC?CNC6YDAO! UW! 4H?MVAS8D! (b\! 38MCXAICH6! 8DDHDO! AOOHXCAI8M! vCIV! A6ICXHAYP?A6I! IV8DAJR! C6! IV8! VHOJCIA?\!/N! *! 0ADMCH?\! :;;e! /PY!<@|!Eefeg9@d:s@\!
!
E\!3H6IA?8OXHI!4W!5HD86IAC6!3W!,ARHI!1!'()*+,) &AD?R! BO! ?AI8! AMNC6COIDAICH6! H_! Y?RXHJDHI8C6! $$Sr$$$A! C6VCSCIHDO! C6! JDCNADR! J8DXPIA68HPO! XHDH6ADR! C6I8DB86ICH6! H_! AXPI8! ()sO8YN86I!
8?8BAICH6! NRHXADMCA?! C6_ADXICH69! A! N8IAs! A6A?ROCO\!-./.0):;;e!|!:E:!9!dm:sm\!
!
<;\!4CSOH6!03W!UCDIA68!/*W!3PDJVR!(/!'()*+,) &AD?R! C6CICAICH6! H_! 8JIC_CSAICM8! C6! IV8! 8N8DY86XR! M8JADIN86I! S8_HD8! JDCNADR! J8DXPIA68HPO!XHDH6ADR!C6I8DB86ICH6!_HD!()s O8YN86I! 8?8BAICH6! NRHXADMCA?! C6_ADXICH69! D8OP?IO! H_! IV8! )CN8! IH! $6I8YDC?C6! )V8DAJR! C6! /XPI8! 3RHXADMCA?! $6_ADXICH6! 9! )$)/#s)$3$! de!IDCA?\!.1)2'*3()-0):;;m!|!<@:!9!mmFsk@!
!
<<\! (ASAIC68! 3(W! 0A66H6! 0,W! 4CSOH6! 43W! 8I! A?\!&__8XI!H_!X?HJCMHYD8?!JD8ID8AIN86I!S8_HD8! J8DXPIA68HPO! XHDH6ADR! C6I8DB86ICH6! C6! JAIC86IO! vCIV! ()s8?8BAICH6! NRHXADMCA?! C6_ADXICH6! ID8AI8M! vCIV! _CSDC6H?RICXO\! )V8! ,0$s01/'$)]! OIPMR\! */3/! :;;@\! :Ee!9<::es <:d:\!
!
<:\!(ASAIC68!3(W!3HDDHv!2/W!3H6IA?8OXHI!4! 8I!A?\!/6YCHYDAJVCX!A6M!X?C6CXA?!HPIXHN8O!C6! JAIC86IO! D8X8CBC6Y! ?HvsNH?8XP?AD! v8CYVI! V8JADC6! C6! ()s8?8BAICH6! NRHXADMCA?! C6_ADXICH6! ID8AI8M! vCIV! _CSDC6H?RICXO! C6! IV8! 01/'$)]s)$3$! :F! IDCA?! 0CDXP?AICH6\! :;;m|! <<:!9!dFems@e\!
!
!
!
!
!
!!
!
!
!
!! <<!
/##&~&!
! ! !
18! JDHIHXH?8! M8! JDCO8! 86! XVADY8! JD7VHOJCIA?C^D8! M8O! (0/! ()h! _ACI! AJJ8?! G! P6! XVHCa! M8! OIDAI7YC8!M8!D8J8D_POCH6!fIVDHNSH?RO8!HP!A6YCHJ?AOIC8!JDCNACD8g!O8?H6!?8O!XCDXH6OIA6X8O! M8!JDCO8!86!XVADY8W!XHNN8!?[C6MCZP8!?8!IAS?8AP!XCsM8OOHPO\!! ! ! ! " ! ! ! !!!!!!! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! !
"68! _HCO! ?A! OIDAI7YC8! M8! D8J8D_POCH6! XVHCOC8W! ?8O! JDHIHXH?8O! IV7DAJ8PICZP8O! PIC?CO7O! JAD! 6HO!7ZPCJ8O!OH6I!?8O!OPCBA6IO!9! ! 4)5673)+*)(836196+:;')<!! /XCM8!AX7IR?OA?CXR?CZP8!:@;NY!f,+!HP!$%gW!! 0?HJCMHYD8?!d;;NY!J8D!HOW!! &6HaAJADC68!SH?PO!M8!d;NY!$%2!8I!<NYrjY!86!OHPO!XPIA67W!;Wk@NYrjY!86!OHPO!XPIA67! O8P?8N86I!JHPD!?8O!J?PO!M8!k@!A6OW!! )768XI7J?AO8!SH?PO!$%!86!MHO8!JHCMO\! ! 4)5673)+=*>?@6A+*;(@')A3@1*@3')<!! /XCM8!AX7IR?OA?CXR?CZP8!:@;NY!f,+!HP!$%gW!! 0?HJCMHYD8?!m;;NY!J8D!HOW!!
/SXCaCNAS! :@;•YrjY! 86! $%1! JPCO! ;W<:@•YrjYrNC6! AP! ,(&! fOA6O! M7JAOO8D! <;•YrNC6gW! -7JADC68!6H6!_DAXICH6678!m;"$rjY!86!SH?PO!$%!fOA6O!M7JAOO8D!e;;;"$g!JPCO!k"$rjYrV!AP! ,(&!fOA6O!M7JAOO8D!<;;;"$rVg\! ! ! ! ! ! ! !
! <:! !
! ! !
/! JADICD! MP! M8PaC^N8! O8N8OID8! :;<;! P6! 6HPB8AP! JDHIHXH?8! A! 7I7! AJJ?CZP7! AP! O8C6! MP! (3"'!M[/668XR\!
! !
!
* Délai porte-porte = délai entre le diagnostic par le médecin pouvant thrombolyser et l’arrivée devant la salle de Cardiologie Interventionnelle.
** Choc ou pré-choc (TA inf. à 100 et FC sup. à 100) ou IDM antérieur étendu ou IDM inférieur étendu. 4)5673)+*)(836196+:;')<!! /XCM8!AX7IR?OA?CXR?CZP8!:@;NY!f,+!HP!$%gW! 0?HJCMHYD8?!d;;NY!J8D!HOW!! &6HaAJADC68!SH?PO!M8!d;NY!$%2!8I!<NYrjY!86!OHPO!XPIA67W!;Wk@NYrjY!86!OHPO!XPIA67! O8P?8N86I!JHPD!?8O!J?PO!M8!k@!A6OW!! )768XI7J?AO8!SH?PO!$%!86!MHO8!JHCMO\! ! 45673)+B*>?@6A+*;(@')A3@1*@3')<) /XCM8!AX7IR?OA?CXR?CZP8!:@;NY!f,+!HP!$%gW!! ,DAOPYD8?!m;NY!HP!X?HJCMHYD8?!m;;NY!J8D!HO!OC!XH6ID8sC6MCXAICH6W!!
5CBA?CDPMC68! SH?PO! C6IDAB8C68Pa! M8! ;\k@! NYrjY! OPCBC! M>P68! J8D_POCH6! XH6IC6P8! M8! <\k@! NYrjYrV\! !
