Bassand Jean-Pierre, Danchin Nicolas, Filippatos Gerasimos, Gitt Anselm, Hamm Christian, Silber Sigmund, Tubaro Marco, Weidinger Franz
Members of the Board of the European Society of Cardiology.
Eur Heart J. 2005 Dec;26(24):2733-41. doi: 10.1093/eurheartj/ehi673. Epub 2005 Nov 25.
Reperfusion therapy in ST-segment elevation myocardial infarction (STEMI) is the most important component of treatment, as it strongly influences short- and long-term patient outcome. The main objective of healthcare providers should be to achieve at least 75% of reperfusion therapy applied to patients suffering from STEMI in a timely manner, and preferably within the first 3 h after onset of symptoms. Establishing networks of reperfusion at regional and national level, implying close collaboration between all the actors involved in reperfusion therapy, namely hospitals, departments of cardiology, PCI centres, emergency medical systems (EMS), (para)medically staffed ambulances, private cardiologists, primary care physicians, etc., is a key issue. All forms of reperfusion, depending on local facilities, need to be available to patients. Protocols must be written and agreed for the strategy of reperfusion to be applied within a network. Early diagnosis of STEMI is essential and is best achieved by rapid ECG recording and interpretation at first medical contact, wherever this contact takes place (hospital or ambulance). Tele-transmission of ECG for immediate interpretation by experienced cardiologists is an alternative. Primary PCI is the preferred reperfusion option if it can be performed by experienced staff within 90 min after first medical contact. Thrombolytic treatment, administered if possible in the pre-hospital setting, is a valid option if PCI cannot be performed in a timely manner, particularly within the first 3 h following onset of symptoms. Thrombolysis is not the end of the reperfusion therapy. Rescue PCI must be performed in the case of thrombolysis failure. Next-day PCI after successful thrombolysis has been proven efficacious. Quality control is important for monitoring the efficacy of networks of reperfusion. All elements that influence time to reperfusion must be taken into account, particularly transfer delays, in-hospital delays, and door-to-balloon or door-to-needle times. The rate of reperfusion achieved must also be taken into consideration. Professional organizations such as the European Society of Cardiology (ESC) have the responsibility to impart this message to the cardiology community, and inform politicians and health authorities about the best possible strategy to achieve reperfusion therapy.
ST段抬高型心肌梗死（STEMI）的再灌注治疗是治疗的最重要组成部分，因为它对患者的短期和长期预后有很大影响。医疗服务提供者的主要目标应该是及时对STEMI患者进行至少75%的再灌注治疗，最好是在症状发作后的前3小时内。在区域和国家层面建立再灌注网络，意味着参与再灌注治疗的所有行为者之间密切合作，即医院、心脏病学部门、PCI中心、紧急医疗系统（EMS）、配备（辅助）医疗人员的救护车、私人心脏病专家、初级保健医生等，这是一个关键问题。根据当地设施情况，所有形式的再灌注都应提供给患者。必须制定并商定在网络内应用再灌注策略的方案。STEMI的早期诊断至关重要，最好通过在首次医疗接触时（无论接触发生在医院还是救护车）快速进行心电图记录和解读来实现。通过远程传输心电图以便经验丰富的心脏病专家立即解读是一种替代方法。如果能由经验丰富的工作人员在首次医疗接触后90分钟内进行，直接经皮冠状动脉介入治疗（PCI）是首选的再灌注选择。如果无法及时进行PCI，特别是在症状发作后的前3小时内，在院前环境中尽可能进行的溶栓治疗是一种有效的选择。溶栓不是再灌注治疗的终点。溶栓失败时必须进行补救性PCI。溶栓成功后次日进行PCI已被证明是有效的。质量控制对于监测再灌注网络的疗效很重要。必须考虑所有影响再灌注时间的因素，特别是转运延迟、院内延迟以及门球时间或门针时间。还必须考虑实现的再灌注率。欧洲心脏病学会（ESC）等专业组织有责任将这一信息传达给心脏病学界，并告知政界人士和卫生当局关于实现再灌注治疗的最佳策略。
