Rao Veena, Safdar Basmah, Parkosewich Janet, Lee L Veronica, D'Onofrio Gail, Foody JoAnne M
Section of Cardiovascular Medicine, Yale University, New Haven, CT, USA.
Crit Pathw Cardiol. 2009 Mar;8(1):38-42. doi: 10.1097/HPC.0b013e318194e443.
Several studies demonstrate that women have greater delays in primary percutaneous coronary intervention (PCI). To improve care for women, the Women's Heart Advantage at Yale-New Haven Hospital (YNHH) developed patient- and physician-level interventions to improve knowledge about chest pain syndromes to promote early presentation, diagnosis, and timely management of ST-elevation myocardial infarction (STEMI) in women presenting to the emergency department. Specifically, we analyzed chart-abstracted data from all patients undergoing PCI for STEMI at YNHH from January 2004 to July 2007 and assessed quality of care for STEMI and trends in time to reperfusion. Women's Heart Advantage and YNHH orchestrated several clinical initiatives and instituted hospital-wide systems to improve STEMI care over this period. Both men and women had declines in time to reperfusion (91-73 minutes for men and 120-74 minutes for women). Notably, improvements in time to reperfusion were more substantial in women; the greatest improvement was reduction in door-to-table time (50% decrease in women vs. 19% decrease in men [P < 0.05]). In this single-site study of men and women undergoing primary PCI at a large, urban teaching hospital, where ongoing interventions to increase both patient and physician awareness regarding heart disease in women were initiated, time to reperfusion for women improved to a greater degree than in men. These results are encouraging, showing that significant improvements can be made over a relatively short time frame. It is hoped these reductions in time to reperfusion are associated with improved outcomes; however, further studies are needed to verify this potential benefit.
多项研究表明，女性在接受直接经皮冠状动脉介入治疗（PCI）时会有更大的延迟。为了改善对女性的治疗，耶鲁-纽黑文医院（YNHH）的女性心脏优势项目制定了针对患者和医生层面的干预措施，以提高对胸痛综合征的认识，促进急诊科就诊的女性ST段抬高型心肌梗死（STEMI）的早期就诊、诊断和及时管理。具体而言，我们分析了2004年1月至2007年7月在YNHH接受STEMI PCI治疗的所有患者的病历摘要数据，并评估了STEMI的治疗质量和再灌注时间趋势。在此期间，女性心脏优势项目和YNHH精心策划了多项临床举措，并建立了全院范围的系统来改善STEMI治疗。男性和女性的再灌注时间均有所下降（男性从91分钟降至73分钟，女性从120分钟降至74分钟）。值得注意的是，女性再灌注时间的改善更为显著；最大的改善是门到球囊扩张时间的缩短（女性减少50%，男性减少19%[P<0.05]）。在这家大型城市教学医院对接受直接PCI的男性和女性进行的单中心研究中，启动了持续的干预措施以提高患者和医生对女性心脏病的认识，女性的再灌注时间比男性有更大程度的改善。这些结果令人鼓舞，表明在相对较短的时间内可以取得显著改善。希望这些再灌注时间的缩短与改善的预后相关；然而，需要进一步研究来证实这种潜在益处。
