Campbell Alex R, Satran Daniel, Larson David M, Chavez Ivan J, Unger Barbara T, Chacko Barbara P, Kapsner Christopher, Henry Timothy D
Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minn.
Circ Cardiovasc Qual Outcomes. 2009 Nov;2(6):648-55. doi: 10.1161/CIRCOUTCOMES.109.861484. Epub 2009 Oct 6.
In the United States, efforts are underway to improve timely access to percutaneous coronary intervention in ST-elevation myocardial infarction (STEMI). The Joint Commission (TJC) and the American College of Cardiology National Cardiovascular Data Registry (NCDR) have developed standardized definitions and clinical performance measures for STEMI. The purpose of this study was to determine differences in 3 quality-assurance registries for STEMI patients.
STEMI patients presenting to the Minneapolis Heart Institute at Abbott Northwestern Hospital (Minneapolis, Minn) are tracked by 3 distinct quality assurance programs: NCDR, TJC, and the level 1 MI registry (a regional system for percutaneous coronary intervention in STEMI which includes transfer patients). Over 1 year, we examined consecutive STEMI patients in level 1 and compared them with individuals meeting NCDR and TJC inclusion criteria. Of 501 STEMI patients treated using the level 1 MI protocol, 422 patients had a clear culprit (402 percutaneous coronary intervention, 13 coronary artery bypass grafting, 7 medical management). In the same period, 282 patients met inclusion criteria for NCDR (56% of the level 1 population), and 66 met inclusion criteria for TJC (13% of the level 1 population). Transfer patients (n=380) accounted for 87% of the discrepancy between level 1 and TJC. Pharmacoinvasive percutaneous coronary intervention (n=102) accounted for 47% of the discrepancy between level 1 and NCDR.
Current inclusion criteria for enrollment in STEMI registries are not uniform. This may lead to variable quality assurance outcomes for the same patient cohort and has important implications for standardized quality measurement.
在美国，正在努力改善ST段抬高型心肌梗死（STEMI）患者及时接受经皮冠状动脉介入治疗的情况。联合委员会（TJC）和美国心脏病学会国家心血管数据注册中心（NCDR）已制定了STEMI的标准化定义和临床性能指标。本研究的目的是确定针对STEMI患者的3个质量保证注册中心之间的差异。
在雅培西北医院明尼阿波利斯心脏研究所（明尼苏达州明尼阿波利斯）就诊的STEMI患者由3个不同的质量保证项目进行跟踪：NCDR、TJC和1级心肌梗死注册中心（STEMI经皮冠状动脉介入治疗的区域系统，包括转诊患者）。在1年多的时间里，我们检查了1级连续的STEMI患者，并将他们与符合NCDR和TJC纳入标准的个体进行比较。在使用1级心肌梗死方案治疗的501例STEMI患者中，422例患者有明确的罪犯血管（402例行经皮冠状动脉介入治疗，13例行冠状动脉旁路移植术，7例接受药物治疗）。同期，282例患者符合NCDR纳入标准（占1级人群的56%），66例符合TJC纳入标准（占1级人群的13%）。转诊患者（n = 380）占1级与TJC之间差异的87%。药物侵入性经皮冠状动脉介入治疗（n = 102）占1级与NCDR之间差异的47%。
目前STEMI注册中心的纳入标准不统一。这可能导致同一患者队列的质量保证结果存在差异，并对标准化质量测量具有重要意义。
