Cannon C P, Gibson C M, Lambrew C T, Shoultz D A, Levy D, French W J, Gore J M, Weaver W D, Rogers W J, Tiefenbrunn A J
Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
JAMA. 2000 Jun 14;283(22):2941-7. doi: 10.1001/jama.283.22.2941.
Rapid time to treatment with thrombolytic therapy is associated with lower mortality in patients with acute myocardial infarction (MI). However, data on time to primary angioplasty and its relationship to mortality are inconclusive.
To test the hypothesis that more rapid time to reperfusion results in lower mortality in the strategy of primary angioplasty.
Prospective observational study of data collected from the Second National Registry of Myocardial Infarction between June 1994 and March 1998.
A total of 661 community and tertiary care hospitals in the United States.
A cohort of 27,080 consecutive patients with acute MI associated with ST-segment elevation or left bundle-branch block who were treated with primary angioplasty.
In-hospital mortality, compared by time from acute MI symptom onset to first balloon inflation and by time from hospital arrival to first balloon inflation (door-to-balloon time).
Using a multivariate logistic regression model, the adjusted odds of in-hospital mortality did not increase significantly with increasing delay from MI symptom onset to first balloon inflation. However, for door-to-balloon time (median time 1 hour 56 minutes), the adjusted odds of mortality were significantly increased by 41% to 62% for patients with door-to-balloon times longer than 2 hours (for 121-150 minutes: odds ratio [OR], 1.41; 95% confidence interval [CI], 1.08-1.84; P=.01; for 151-180 minutes: OR, 1.62; 95% CI, 1.23-2.14; P<.001; and for >180 minutes: OR, 1.61; 95% CI, 1.25-2.08; P<.001).
The relationship in our study between increased mortality and delay in door-to-balloon time longer than 2 hours (present in nearly 50% of this cohort) suggests that physicians and health care systems should work to minimize door-to-balloon times and that door-to-balloon time should be considered when choosing a reperfusion strategy. Door-to-balloon time also appears to be a valid quality-of-care indicator. JAMA. 2000.
急性心肌梗死（MI）患者接受溶栓治疗的时间越快，死亡率越低。然而，关于首次血管成形术的时间及其与死亡率的关系的数据尚无定论。
检验在首次血管成形术策略中，更快的再灌注时间会导致更低死亡率这一假设。
对1994年6月至1998年3月期间从第二次全国心肌梗死登记处收集的数据进行前瞻性观察研究。
美国总共661家社区医院和三级医疗中心。
一组连续27080例伴有ST段抬高或左束支传导阻滞的急性MI患者，接受了首次血管成形术治疗。
根据从急性MI症状发作到首次球囊扩张的时间以及从入院到首次球囊扩张的时间（门球时间）比较住院死亡率。
使用多变量逻辑回归模型，从MI症状发作到首次球囊扩张的延迟增加，住院死亡率的校正比值并未显著增加。然而，对于门球时间（中位时间1小时56分钟），门球时间超过2小时的患者，死亡率的校正比值显著增加41%至62%（121 - 150分钟：比值比[OR]，1.41；95%置信区间[CI]，1.08 - 1.84；P = 0.01；151 - 180分钟：OR，1.62；95% CI，1.23 - 2.14；P < 0.001；>180分钟：OR，1.61；95% CI，1.25 - 2.08；P < 0.001）。
我们的研究中死亡率增加与门球时间超过2小时的延迟之间的关系（该队列中近50%的患者存在这种情况）表明，医生和医疗保健系统应努力缩短门球时间，并且在选择再灌注策略时应考虑门球时间。门球时间似乎也是一个有效的医疗质量指标。《美国医学会杂志》。2000年。
