Klinik III für Innere Medizin, Universitaet zu Koeln, Kerpener Strasse 62, 50937 Cologne, Germany.
Circ Cardiovasc Interv. 2008 Oct;1(2):95-102. doi: 10.1161/CIRCINTERVENTIONS.108.768176. Epub 2008 Sep 3.
The aim of the Köln (Cologne) Infarction Model is to examine the feasibility of obligatory treatment of ST-segment-elevation myocardial infarction (STEMI) by first-line percutaneous coronary intervention.
The study was performed in Cologne with >1 million citizens, 5 coronary intervention centers, and 11 primary care hospitals. Twelve-lead ECG was available for all emergency medical service (EMS) teams. Partners guaranteed direct transfer of STEMI patients to a catheterization laboratory. A total of 519 patients treated within KIM in 2006 were included in the study. Of these, 24% presented at a primary care hospital, 11% presented directly at a coronary intervention center, 5% were transferred by EMS to primary care hospitals, and 60% were directly transferred by EMS to a catheterization laboratory. In 91% of cases, the catheterization laboratory was notified of the patient's arrival in advance. False-positive ECG diagnosis of STEMI by EMS accounted for 6%. Median treatment times were as follows: from the start of symptoms to first medical contact, 120 minutes; phone to balloon, 70 minutes; and door to balloon, 49 minutes. Of all patients, 93% underwent angiography; 409 patients were treated by coronary intervention, and 24 underwent emergency coronary artery bypass graft. Thrombolysis in Myocardial Infarction grade 3 flow was obtained in 89%. In the hospitals, deaths and new myocardial infarctions were observed in 12.1% and in 1.9% of all patients, respectively.
The Cologne Infarction Model provides evidence for the feasibility of obligatory treatment of STEMI by primary coronary intervention in a metropolitan setting. Acceptance of treatment pathways allowed nearly all STEMI patients to undergo coronary angiography. ECG competence of EMS was excellent. Treatment times were within postulated limits. Results, including mortality, were within a high quality range.
科隆（Cologne）梗塞模型旨在研究通过一线经皮冠状动脉介入治疗强制性治疗 ST 段抬高型心肌梗死（STEMI）的可行性。
该研究在拥有超过 100 万居民、5 个冠状动脉介入中心和 11 家初级保健医院的科隆进行。所有紧急医疗服务（EMS）团队都可获得 12 导联心电图。合作伙伴保证将 STEMI 患者直接转至导管实验室。共有 519 例 2006 年在 KIM 治疗的患者纳入研究。其中，24%在初级保健医院就诊，11%直接在冠状动脉介入中心就诊，5%通过 EMS 转至初级保健医院，60%由 EMS 直接转至导管实验室。在 91%的情况下，导管实验室事先接到了患者到达的通知。EMS 对 STEMI 的心电图诊断假阳性率为 6%。中位治疗时间如下：从症状发作到首次医疗接触为 120 分钟；电话至球囊扩张为 70 分钟；门至球囊扩张为 49 分钟。所有患者中，93%接受了血管造影；409 例接受冠状动脉介入治疗，24 例接受紧急冠状动脉旁路移植术。心肌梗死溶栓治疗分级 3 级血流达到 89%。在医院中，死亡和新发心肌梗死分别在 12.1%和 1.9%的患者中观察到。
科隆梗塞模型为在大都市环境中通过初级冠状动脉介入治疗强制性治疗 STEMI 提供了可行性证据。治疗途径的接受使几乎所有 STEMI 患者都能接受冠状动脉造影。EMS 的心电图能力非常出色。治疗时间在推测的范围内。包括死亡率在内的结果均处于高质量范围。
