Service de cardiologie et maladies vasculaires, CHU de Rennes, Rennes, France.
Arch Cardiovasc Dis. 2009 Nov;102(11):777-84. doi: 10.1016/j.acvd.2009.08.004. Epub 2009 Oct 29.
Minimizing delays to coronary reperfusion is critical in the management of acute myocardial infarction (AMI).
To determine delays in in-hospital management and factors associated with delays of over 45min.
We analysed data from the Observatoire Régional Breton sur l'Infarctus, a registry of AMI patients admitted within 24h of symptom onset (July 2007 to December 2008) to an interventional cardiology centre in Brittany. Prehospital delay was defined as time between first responder arrival at the patient and patient arrival at an interventional cardiovascular centre. In-hospital delay was defined as time between admission to the interventional cardiovascular centre and first balloon inflation. Patients were grouped according to duration of in-hospital delay (>45 vs <or=45min). Predictors of short in-hospital delay (<or=45min) were examined by logistic regression analysis.
The analysis included 560 patients (mean age 60.7+/-13 years; 443 men). Median delay between symptom onset and call for medical assistance was 50min (mean 115+/-180). Two-thirds (n=371) of patients were admitted to hospital during working hours (08:00-20:00h); 383 (68%) patients were managed by emergency medical services before admission. In-hospital delay was less than or equal to 45min for 296 (53%) patients. The mean overall (pre- and in-hospital) delay was 140 (median 109) min. Direct admission to a catheterization laboratory and admission during working hours were independently correlated with short in-hospital delay (odds ratios 20.8 [p<0.001] and 2.37 [p=0.004], respectively).
In Brittany, median in-hospital delay before treatment of AMI by primary angioplasty was over 45min in 50% of patients. Overall, delays were longer than recommended, due to excessively long prehospital delays. Patient admission during working hours and direct admission to a catheterization laboratory were associated with short in-hospital delay.
在急性心肌梗死（AMI）的治疗中，将再灌注时间延迟最小化至关重要。
确定住院管理中的延迟以及与超过 45 分钟延迟相关的因素。
我们分析了Observatoire Régional Breton sur l'Infarctus 的数据，该数据是对布列塔尼地区一个介入心脏病学中心在症状发作后 24 小时内收治的 AMI 患者的登记。院前延迟定义为急救人员到达患者处与患者到达介入心血管中心之间的时间。住院期间的延迟定义为从入住介入心血管中心到首次球囊充气之间的时间。根据住院期间延迟的时间（>45 分钟与<=45 分钟）将患者分组。使用逻辑回归分析检查住院期间短延迟（<=45 分钟）的预测因素。
该分析纳入了 560 名患者（平均年龄 60.7+/-13 岁；443 名男性）。症状发作与医疗求助之间的中位延迟时间为 50 分钟（平均 115+/-180）。三分之二（n=371）的患者在工作时间（08:00-20:00）入院；383 名（68%）患者在入院前由紧急医疗服务管理。296 名（53%）患者的住院期间延迟<=45 分钟。总的（院前和院内）平均延迟为 140（中位数 109）分钟。直接入院至导管实验室和在工作时间入院与院内延迟时间短独立相关（优势比 20.8[P<0.001]和 2.37[P=0.004]）。
在布列塔尼，接受直接经皮冠状动脉介入治疗的 AMI 患者的住院期间中位数延迟超过 45 分钟的占 50%。总的来说，由于院前延迟时间过长，延迟时间长于推荐时间。在工作时间入院和直接入院至导管实验室与院内延迟时间短有关。
