Ostrzycki Adam, Sosnowski Cezary, Borowiec-Kocańda Anna, Zera Tymoteusz, Pieńkowska Katarzyna, Drop-Dzwonkowska Dobromiła, Chwyczko Tomasz, Kowalik Ilona, Szwed Hanna
The cardinal Stefan Wyszyński Institute of Cardiology, Warsaw, Poland.
Kardiol Pol. 2008 Jun;66(6):609-14; discussion 615-6.
Early reperfusion therapy with primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) improves left ventricular function and reduces mortality.
To assess the time delay in treatment of patients with STEMI referred to a twenty-four-hour interventional centre located in the vicinity of the centre of Warsaw.
We analysed 350 consecutive STEMI patients admitted to our Department between October 2005 and September 2006. The majority of the patients - 244 (69.7%), were admitted via hospitals without an interventional department. Sixty-two (17.7%) patients were transported directly by ambulance from home, 34 (9.7%) from a community health centre and 10 patients (2.9%) came by themselves from home or work. A detailed interview concerning the time of symptom onset was conducted in 342 patients (97.7%).
Sixty-two (18%) patients arrived at the interventional centre within the first 2 hours from symptom onset: 6 women (5.5% of all women in the study population) and 56 (24.1%) men (p <0.0001). Within the first 2 hours, 32 (13.1%) patients were admitted via another hospital and 20 (32.2%) directly by ambulance (p <0.001). During the first 7 days of hospitalisation the following patients died: 2 (3.2%) patients admitted within the first 2 hours via another hospital, 6 (3.4%) patients among 178 admitted between 2 and 6 hours after pain onset, 4 (8.3%) among 48 admitted between 6 and 12 hours and 8 (14.8%) among 54 patients with the pain duration over 12 hours (p <0.02). During the first 7 days of hospitalisation 8 (3.3%) patients admitted within the first 6 hours after pain onset died compared with 12 (11.8%) admitted later (p <0.003).
In the interventional centre located near the centre of Warsaw symptom-onset-to-door time was 120 minutes only in 18% of patients with STEMI. Almost 70% of patients underwent interhospital transfer for primary PCI. Prolongation of the time from onset of symptoms to successful PCI worsened prognosis. When transporting patients with acute coronary syndrome, efforts should be made to avoid district hospitals without a catheterisation laboratory. Direct transportation by ambulance or helicopter with educated staff equipped with ECG teletransmission data, which may substantially shorten time to treatment, should be preferred.
对ST段抬高型心肌梗死（STEMI）患者进行早期再灌注治疗并实施直接经皮冠状动脉介入治疗（PCI）可改善左心室功能并降低死亡率。
评估转诊至位于华沙市中心附近的24小时介入中心的STEMI患者的治疗时间延迟情况。
我们分析了2005年10月至2006年9月期间连续收治入我科的350例STEMI患者。大多数患者——244例（69.7%），是通过没有介入科室的医院收治的。62例（17.7%）患者由救护车直接从家中转运而来，34例（9.7%）从社区卫生中心转运而来，10例患者（2.9%）从家中或工作单位自行前来。对342例患者（97.7%）进行了关于症状发作时间的详细访谈。
62例（18%）患者在症状发作后的前2小时内抵达介入中心：6例女性（占研究人群中所有女性的5.5%）和56例（24.1%）男性（p<0.0001）。在前2小时内，32例（13.1%）患者通过另一家医院收治，20例（32.2%）由救护车直接送来（p<0.001）。在住院的前7天内，以下患者死亡：2例（3.2%）在前2小时内通过另一家医院收治的患者，178例在疼痛发作后2至6小时内收治的患者中有6例（3.4%），48例在6至12小时内收治的患者中有4例（8.3%），54例疼痛持续时间超过12小时的患者中有8例（14.8%）（p<0.02）。在住院的前7天内，疼痛发作后6小时内收治的8例（3.3%）患者死亡，而之后收治的12例（11.8%）患者死亡（p<0.003）。
在位于华沙市中心附近的介入中心，仅18%的STEMI患者症状发作至入院时间为120分钟。近70%的患者为接受直接PCI而进行院间转运。从症状发作到成功进行PCI的时间延长会使预后恶化。在转运急性冠状动脉综合征患者时，应努力避免转运至没有导管室的区级医院。应优先选择由配备有心电图远程传输数据的专业人员通过救护车或直升机进行直接转运，这可大幅缩短治疗时间。
