Huynh Thao, O'Loughlin Jennifer, Joseph Lawrence, Schampaert Erick, Rinfret Stéphane, Afilalo Marc, Kouz Simon, Cantin Bernard, Nguyen Michel, Eisenberg Mark J
Division of Cardiology, Department of Cardiology, Montreal General Hospital, Montréal, Quebec, Canada.
CMAJ. 2006 Dec 5;175(12):1527-32. doi: 10.1503/cmaj.060359.
Through the AMI-QUEBEC Study we sought to describe delays to reperfusion therapy for ST-segment elevation myocardial infarction (STEMI) and to identify factors associated with prolonged delays.
We reviewed the charts of all consecutive patients with STEMI admitted to 17 hospitals in the province of Quebec in 2003 to obtain data on the time from presentation to reperfusion therapy. Data were available for 1189 (83.0%) of 1432 patients.
The median delay to reperfusion therapy was 32 minutes (first and third quartile [Q1, Q3] 20, 49) for 535 patients who received fibrinolytic therapy, 109 minutes (Q1, Q3 79, 150) for 455 patients who underwent primary percutaneous coronary intervention (PCI) at the initial hospital of presentation and 142 minutes (Q1, Q3 115, 194) for 199 patients who underwent primary PCI after an interhospital transfer. Patients who presented outside daytime working hours, those who received primary PCI and those who required interhospital transfer for primary PCI were less likely to receive reperfusion therapy within current recommended times (odds ratios [ORs] 0.49, 0.56 and 0.15, respectively). Increased age was associated with prolonged delays only among patients who received fibrinolytic therapy (OR for each 10-year increase in age 0.95, 95% credible interval [CrI] 0.93-0.99 for fibrinolytic therapy and 0.99, 95% CrI 0.95-1.05, for primary PCI).
In 2003, many patients with STEMI in Quebec were not treated within the recommended times. Delays may be reduced by reorganizing pre-and in-hospital care for patients with STEMI to expedite delivery of reperfusion therapy.
通过魁北克急性心肌梗死（AMI）研究，我们试图描述ST段抬高型心肌梗死（STEMI）患者接受再灌注治疗的延迟情况，并确定与延迟时间延长相关的因素。
我们回顾了2003年魁北克省17家医院收治的所有连续性STEMI患者的病历，以获取从就诊到接受再灌注治疗的时间数据。1432例患者中有1189例（83.0%）的数据可用。
535例接受溶栓治疗的患者，再灌注治疗的中位延迟时间为32分钟（第一和第三四分位数[Q1，Q3]分别为20、49）；455例在首诊医院接受直接经皮冠状动脉介入治疗（PCI）的患者，延迟时间为109分钟（Q1，Q3为79、150）；199例在院间转运后接受直接PCI的患者，延迟时间为142分钟（Q1，Q3为115、194）。在非白天工作时间就诊的患者、接受直接PCI的患者以及需要院间转运以接受直接PCI的患者，在当前推荐时间内接受再灌注治疗的可能性较小（优势比[OR]分别为0.49、0.56和0.15）。仅在接受溶栓治疗的患者中，年龄增加与延迟时间延长相关（溶栓治疗中年龄每增加10岁，OR为0.95，95%可信区间[CrI]为0.93 - 0.99；直接PCI为0.99，95% CrI为0.95 - 1.05）。
2003年，魁北克省许多STEMI患者未在推荐时间内接受治疗。通过重组STEMI患者的院前和院内护理，以加快再灌注治疗的实施，可能会减少延迟。
