Dobrić Milan, Ostojić Miodrag, Nedeljković Milan, Vukcević Vladan, Stanković Goran, Stojković Sinisa, Veleslić Branko, Orlić Dejan, Vasiljević Zorana, Lazić Branislav
Srp Arh Celok Lek. 2007 Sep-Oct;135(9-10):521-31.
Treatment of patients with acute ST elevation myocardial infarction starts after the onset of chest pain, involves contacts with medical services, aimed at attempting to recanalize the infarct-related artery with primary percutaneous coronary intervention. True ischaemic time correlates with the extent of myocardial necrosis, and it is essential to reduce every unnecessary time loss. It has been proven that antiaggregational therapy has an important effect on reopening of the infarct-related artery, function of microcirculation and prevention of stent thrombosis.
The aim of this study was to determine movement and treatment of patients, from the onset of symptoms till leaving the catheterization laboratory, and, if necessary, to propose corrections according to medical guidelines and medicolegal obligations.
This study presents a part of a larger project, designed in three phases. Here are presented the first two completed phases. The first phase enrolled the total of 228 patients, with retrospective acquisition of data from the medical documentation. In the second phase, the total of 277 patients were enrolled, and data were collected with special graphico-textual form upon the patient's arrival to the catheterization lab. Data were checked with the First-Aid Station of Belgrade and the Department of Emergency Cardiology of our Clinic. In the third phase, it has been planned to improve the graphico-textual form and to distribute it to all institutions involved in treatment of these patients.
The patients mainly moved centrifugally--from the catheterization lab (in this manner, 95% of patients were transferred by the first-aid station, and 31% patients were sent from other hospitals), instead of centripetally--towards the catheterization lab. The median time of reaction of the First-Aid Station of Belgrade was 15 minutes. The median of true ischaemic time was 260 minutes; the median time from the onset of chest pain to diagnostic ECG was 60 minutes, while the median time from diagnostic EKG to the first balloon inflation was 177 minutes. Upon arrival to the catheterization lab, a median of 18 minutes passed till the insertion of the catheter, and the median procedure duration was 35 minutes. Dual antiaggregational therapy was administered relatively late on the way to the catheterization lab (the first-aid station missed the opportunity to administer clopidogrel in 84% of patients, aspirin in 86%, other hospitals did not administer clopidogrel in 40% and aspirin in 41% of patients).
Optimal medical data acquisition is essential for the quality assessment of health services. Our data indicate that in logistics and organization of treatment of patients with acute ST elevation myocardial infarction, further improvements could be made in order to implement official guidelines and medicolegal obligations. The third phase of this project is necessary to achieve these objectives.
急性ST段抬高型心肌梗死患者的治疗在胸痛发作后开始，涉及与医疗服务机构的联系，目的是通过直接经皮冠状动脉介入治疗使梗死相关动脉再通。真正的缺血时间与心肌坏死程度相关，减少一切不必要的时间损失至关重要。已证实抗聚集治疗对梗死相关动脉再通、微循环功能及预防支架血栓形成具有重要作用。
本研究旨在确定患者从症状发作到离开导管室的转运及治疗情况，如有必要，根据医学指南和法医学义务提出改进建议。
本研究是一个更大项目的一部分，该项目分三个阶段设计。这里展示的是前两个已完成阶段。第一阶段共纳入228例患者，从医疗记录中回顾性获取数据。第二阶段共纳入277例患者，患者到达导管室时通过特殊图文形式收集数据。数据与贝尔格莱德急救站及我们诊所的急诊心脏病科进行核对。第三阶段计划改进图文形式并分发给所有参与这些患者治疗的机构。
患者主要是离心转运——从导管室转出（通过这种方式，95%的患者由急救站转运，31%的患者从其他医院送来），而非向心转运——前往导管室。贝尔格莱德急救站的中位反应时间为15分钟。真正缺血时间的中位数为260分钟；从胸痛发作到诊断性心电图的中位时间为60分钟，而从诊断性心电图到首次球囊扩张的中位时间为177分钟。到达导管室后，插入导管的中位时间为18分钟，手术中位持续时间为35分钟。双联抗聚集治疗在前往导管室的途中给予相对较晚（急救站在84%的患者中错过给予氯吡格雷的机会，在86%的患者中错过给予阿司匹林的机会，其他医院在40%的患者中未给予氯吡格雷，在41%的患者中未给予阿司匹林）。
最佳医疗数据采集对于卫生服务质量评估至关重要。我们的数据表明，在急性ST段抬高型心肌梗死患者治疗的后勤和组织方面，为落实官方指南和法医学义务可进一步改进。该项目的第三阶段对于实现这些目标是必要的。
