Aguirre Frank V, Varghese Joji J, Kelley Michael P, Lam Wilfred, Lucore Charles L, Gill John B, Page Lisa, Turner Leah, Davis Conrad, Mikell Frank L
Prairie Cardiovascular Consultants, Ltd, PO Box 19420, Springfield, IL 62794-9420, USA.
Circulation. 2008 Mar 4;117(9):1145-52. doi: 10.1161/CIRCULATIONAHA.107.728519. Epub 2008 Feb 11.
In Europe, interhospital transfer of ST-elevation myocardial infarction (STEMI) patients for primary percutaneous coronary intervention (PCI) from non-PCI-capable (STEMI-referral) to PCI-capable (STEMI-accepting) facilities has been shown to be a superior reperfusion strategy compared with on-site fibrinolysis. The feasibility of such programs in the United States remains poorly defined.
We describe an observational cohort of 230 consecutive presumed STEMI patients who underwent interhospital transfer between January 2005 and March 2007 among 6 STEMI-referral and 2 STEMI-accepting hospitals in rural central Illinois. A standard treatment protocol using rapid interhospital transfer for primary PCI or rescue PCI after full-dose intravenous fibrinolysis (in event of unanticipated transfer delays) was initiated by the STEMI-referral emergency department physician. Three time intervals were evaluated: STEMI-referral care (door 1 to departure), transport time (door 1 departure to STEMI-accepting hospital arrival [door 2]), and STEMI-accepting hospital care (door 2 to balloon). Primary PCI was performed in 165 STEMI-confirmed patients (87.7%), whereas fibrinolysis was required in 16 patients (8.5%), with 56% undergoing rescue PCI. The median door 1-to-departure time was 46 minutes (25th and 75th percentiles, 32 and 62 minutes); approximately two thirds of this delay was attributable to the wait for transport arrival and departure. The transport and door 2-to-balloon times were 29 minutes (25th and 75th percentiles, 25 and 35 minutes) and 35 minutes (25th and 75th percentiles, 32 and 46 minutes), respectively. The door 1-to-balloon time was 117 minutes (25th and 75th percentiles, 98 and 137 minutes), with 12.2% and 58% of patients achieving a time of < or = 90 and < or = 120 minutes, respectively. No adverse clinical events occurred during interhospital transport.
In rural US communities, emergency department physician-initiated interhospital transfer of STEMI patients for primary or rescue PCI is feasible and was safely executed with achievement of timely reperfusion when performed within coordinated healthcare networks.
在欧洲，将ST段抬高型心肌梗死（STEMI）患者从无初级经皮冠状动脉介入治疗（PCI）能力的医院（STEMI转诊医院）转至有PCI能力的医院（STEMI接收医院）进行初级PCI已被证明是一种优于现场溶栓的再灌注策略。此类项目在美国的可行性仍不明确。
我们描述了一个观察性队列，该队列由230例连续的疑似STEMI患者组成，这些患者于2005年1月至2007年3月期间在伊利诺伊州中部农村地区的6家STEMI转诊医院和2家STEMI接收医院之间进行了院际转运。STEMI转诊急诊科医生启动了一项标准治疗方案，即在全剂量静脉溶栓后（如出现意外转运延迟），采用快速院际转运进行初级PCI或补救性PCI。评估了三个时间间隔：STEMI转诊治疗（门1至离开）、转运时间（门1离开至STEMI接收医院到达[门2]）和STEMI接收医院治疗（门2至球囊扩张）。165例确诊为STEMI的患者（87.7%）接受了初级PCI，而16例患者（8.5%）需要溶栓，56%的患者接受了补救性PCI。门1至离开的中位时间为46分钟（第25和第75百分位数分别为32和62分钟）；该延迟的约三分之二归因于等待转运到达和离开。转运时间和门2至球囊扩张时间分别为29分钟（第25和第75百分位数分别为25和35分钟）和35分钟（第25和第75百分位数分别为32和46分钟）。门1至球囊扩张时间为117分钟（第25和第75百分位数分别为98和137分钟），分别有12.2%和58%的患者达到≤90分钟和≤120分钟的时间。院际转运期间未发生不良临床事件。
在美国农村社区，由急诊科医生启动的将STEMI患者进行院际转运以进行初级或补救性PCI是可行的，并且在协调的医疗网络内进行时能够安全实施并实现及时再灌注。
