Scholz Karl Heinrich, Hilgers Reinhard, Ahlersmann Dorothe, Duwald Holger, Nitsche Rolf, von Knobelsdorff Georg, Volger Berthold, Möller Karsten, Keating Friederike K
Department of Cardiology, St. Bernward Hospital, Hildesheim, Germany.
Am J Cardiol. 2008 Jan 1;101(1):46-52. doi: 10.1016/j.amjcard.2007.07.078. Epub 2007 Nov 19.
For many patients with ST-segment elevation myocardial infarctions (STEMIs), the time from presentation to percutaneous coronary intervention exceeds established goals. This study was conducted to examine the effects of formalized data assessment and systematic feedback on treatment times. All patients with STEMIs treated with percutaneous coronary intervention in a semi-rural 3-hospital network from January 1, 2006, to December 31, 2006, were prospectively analyzed (n = 114). Patients presenting during the first 3-month period (January 1, 2006, to March 31, 2006) were included as the reference group (n = 33). Time points from initial contact with the medical system to revascularization were assessed, analyzed, and presented in an interactive session to hospital and emergency services staff members. Data from patients with STEMIs presenting during the next 3 quarters were presented in the same manner (n = 28, 25, and 28). The median contact-to-balloon time was 113 minutes in the reference quarter, decreasing to 83, 66, and 74 minutes in the intervention groups (p <0.0001), whereas the median door-to-balloon time decreased from 54 minutes in the reference group to 35, 31, and 26 minutes in the intervention groups (p <0.0001). The proportion of patients with contact-to-balloon times <90 minutes increased from 21% to 79% (p <0.0001). There were significant reductions in the durations of initial treatment on location and in the emergency room and in puncture-to-balloon-time in the catheterization laboratory, and more patients were transported directly to the catheterization laboratory, bypassing the emergency room (from 23% in the reference quarter to 76% in the last intervention quarter, p <0.0001). In conclusion, formalized data feedback leads to marked reduction in revascularization times in patients with STEMIs.
对于许多ST段抬高型心肌梗死（STEMI）患者而言，从就诊到接受经皮冠状动脉介入治疗的时间超过了既定目标。本研究旨在探讨规范化数据评估和系统性反馈对治疗时间的影响。对2006年1月1日至2006年12月31日期间在一个半乡村三医院网络中接受经皮冠状动脉介入治疗的所有STEMI患者进行前瞻性分析（n = 114）。将在第一个3个月期间（2006年1月1日至2006年3月31日）就诊的患者作为参照组（n = 33）。对从首次接触医疗系统到血管再通的各个时间点进行评估、分析，并在一次互动会议上向医院和急救服务人员展示。以同样方式展示了在接下来3个季度就诊的STEMI患者的数据（n = 28、25和28）。参照季度的中位接触至球囊扩张时间为113分钟，在干预组中分别降至83分钟、66分钟和74分钟（p<0.0001），而中位门至球囊扩张时间从参照组的54分钟降至干预组的35分钟、31分钟和26分钟（p<0.0001）。接触至球囊扩张时间<90分钟的患者比例从21%增至79%（p<0.0001）。现场初始治疗和急诊室治疗的时长以及导管室穿刺至球囊扩张时间均显著缩短，更多患者绕过急诊室直接被送往导管室（从参照季度的23%增至最后一个干预季度的76%，p<0.0001）。总之，规范化数据反馈可显著缩短STEMI患者的血管再通时间。
