直接经皮冠状动脉介入治疗（PCI）治疗的 ST 段抬高型心肌梗死（STEMI）患者的院前诊断：快速再灌注的关键。

Prehospital diagnosis in STEMI patients treated by primary PCI: the key to rapid reperfusion.

机构信息

Department of Cardiology, Thoraxcentre, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands.

出版信息

Neth Heart J. 2008;16(1):5-9. doi: 10.1007/BF03086109.

DOI:10.1007/BF03086109

PMID:18317537

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2246312/

Abstract

BACKGROUND

Primary coronary intervention (PCI) for acute myocardial infarction should be performed as quickly as possible, with a door-toballoon time of less then 90 minutes. However, in daily practice this cannot always be achieved. Prehospital diagnosis of ST-elevation myocardial infarction (STEMI) is of major importance in reducing time to treatment, in particular when patients can be transported directly to a centre with interventional capacities.

OBJECTIVES

The aim of the current study was to evaluate the time from prehospital diagnosis of STEMI to balloon inflation and identify factors related to treatment delay in patients directly referred to the catheterisation laboratory of the University Medical Centre of Groningen.

METHODS

A cross-sectional descriptive design was used to collect data on patients treated with primary PCI after prehospital diagnosis of STEMI.

RESULTS

Median prehospital diagnosis-to-balloon time was 64 minutes for patients directly admitted to the catheterisation laboratory and 75 minutes for patients initially admitted to the coronary care unit. A delay longer than 90 minutes was observed in 18 patients. Higher age was associated with longer delay times (p=0.041). Long delays were not associated with diabetes (p=0.293), time from symptom onset to prehospital diagnosis (p=0.87) or time of day (p=0.09). Initial unavailability of the catheterisation laboratory due to running procedures contributed to longer delay times in ten cases.

CONCLUSION

Prehospital diagnosis of STEMI and direct referral to a catheterisation laboratory for primary PCI allows a prehospital diagnosis-toballoon time of less than 90 minutes in 82% of patients. Older patients are at risk of longer delays. (Neth Heart J 2008;16:5-9.).

摘要

背景

急性心肌梗死的主要介入治疗（PCI）应尽快进行，门球时间应少于 90 分钟。然而，在日常实践中，这并不总是能够实现。ST 段抬高型心肌梗死（STEMI）的院前诊断对于减少治疗时间至关重要，特别是当患者可以直接被送往具有介入能力的中心时。

目的

本研究旨在评估从院前 STEMI 诊断到球囊充气的时间，并确定直接转至格罗宁根大学医学中心导管室治疗的患者中与治疗延迟相关的因素。

方法

采用横断面描述性设计，收集经院前诊断为 STEMI 后行直接 PCI 治疗患者的数据。

结果

中位数为 64 分钟，直接收入导管室的患者的院前诊断至球囊充气时间为 64 分钟，最初收入冠心病监护病房的患者为 75 分钟。18 例患者观察到延迟时间超过 90 分钟。年龄较大与较长的延迟时间相关（p=0.041）。较长的延迟时间与糖尿病无关（p=0.293）、症状发作至院前诊断的时间无关（p=0.87）或时间无关（p=0.09）。由于正在进行操作，导管室最初无法使用，这导致 10 例患者的延迟时间延长。