Holmes David R, Bell Malcolm R, Gersh Bernard J, Rihal Charanjit S, Haro Luis H, Bjerke Christine M, Lennon Ryan J, Lim Choon-Chern, Ting Henry H
Division of Cardiovascular Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
JACC Cardiovasc Interv. 2008 Feb;1(1):88-96. doi: 10.1016/j.jcin.2007.10.002.
We implemented the Mayo Clinic ST-segment elevation myocardial infarction (STEMI) protocol and evaluated the timeliness of reperfusion therapy during off hours versus regular hours.
Patients with STEMI who present during off hours have longer door-to-balloon times and door-to-needle times.
The Mayo STEMI protocol was implemented in May 2004 to optimize timeliness of reperfusion therapy for STEMI patients presenting to Saint Mary's Hospital, a tertiary facility with on-site percutaneous coronary intervention (PCI), and for those presenting to 28 regional hospitals located up to 150 miles away from Saint Mary's Hospital. We compared door-to-balloon times and door-to-needle times for 597 consecutive patients who presented during off hours (weekdays from 5 pm to 7 am and any time on weekends or holidays) versus regular hours (weekdays from 7 am to 5 pm). In 2003, prior to implementing the protocol, median door-to-balloon time at Saint Mary's Hospital was 85 min during regular hours and 98 min during off hours.
Among 258 patients who presented to Saint Mary's Hospital, median door-to-balloon time was 65 min during regular hours versus 74 min during off hours (p = 0.085). Among 105 patients transferred from regional hospitals for primary PCI, median door-to-balloon time was 118 min during regular hours versus 114 min during off hours (p = 0.15). Among 131 patients treated with fibrinolytic therapy at regional hospitals, median door-to-needle time was 21 min during regular hours versus 26 min during off hours (p = 0.067).
The Mayo Clinic STEMI protocol demonstrates the rapid times that can be achieved through coordinated systems of care for STEMI patients presenting during off hours and regular hours.
我们实施了梅奥诊所ST段抬高型心肌梗死（STEMI）治疗方案，并评估了非工作时间与正常工作时间再灌注治疗的及时性。
在非工作时间就诊的STEMI患者，其门球时间和门针时间更长。
2004年5月实施了梅奥STEMI治疗方案，以优化在圣玛丽医院（一家具备现场经皮冠状动脉介入治疗（PCI）的三级医疗机构）就诊的STEMI患者以及在距离圣玛丽医院达150英里远的28家地区医院就诊的STEMI患者的再灌注治疗及时性。我们比较了597例连续患者的门球时间和门针时间，这些患者分别在非工作时间（工作日下午5点至上午7点以及周末或节假日的任何时间）和正常工作时间（工作日上午7点至下午5点）就诊。2003年，在实施该方案之前，圣玛丽医院正常工作时间的门球时间中位数为85分钟，非工作时间为98分钟。
在前往圣玛丽医院就诊的258例患者中，正常工作时间的门球时间中位数为65分钟，非工作时间为74分钟（p = 0.085）。在从地区医院转来接受直接PCI的患者中的105例患者中，正常工作时间的门球时间中位数为118分钟，非工作时间为114分钟（p = 0.15）。在地区医院接受溶栓治疗的131例患者中，正常工作时间的门针时间中位数为21分钟，非工作时间为26分钟（p = 0.067）。
梅奥诊所STEMI治疗方案表明，对于在非工作时间和正常工作时间就诊的STEMI患者，通过协调的医疗系统可以实现快速治疗。
