Department of Cardiology, Box Hill Hospital, Melbourne, VIC, Australia.
Med J Aust. 2010 Jun 21;192(12):702-7. doi: 10.5694/j.1326-5377.2010.tb03707.x.
To compare clinical outcomes between patients with ST-elevation myocardial infarction (STEMI) presenting to a hospital with facilities for primary percutaneous coronary intervention (PCI) and patients transferred from a non-PCI-capable unit, and to determine the success rate of meeting clinical guidelines for management of STEMI.
DESIGN, SETTING AND PARTICIPANTS: Prospective study of patients with STEMI who underwent PCI at Box Hill Hospital (BHH), Melbourne, between 1 July 2002 and 30 June 2008. We compared two patient groups: "BHH patients", who were admitted directly to BHH (a hospital with PCI capability), and "SHIPEM (Shipping Infarcts for Primary Angioplasty in Eastern Melbourne Registry) patients", who were transferred from other hospitals without PCI capability.
Clinical outcomes; symptom-to-first-door time (time between symptom onset and arrival at first hospital); first-door-to-balloon time (time between arrival at the first hospital and inflation of the angioplasty balloon); compliance with Cardiac Society of Australia and New Zealand/National Heart Foundation of Australia (CSANZ/NHFA) guidelines for management of patients with STEMI.
There were 598 patients in the BHH group and 189 in the SHIPEM group. The median first-door-to-balloon time was 89 minutes (interquartile range [IQR], 69-107 minutes) for BHH patients and 128 minutes (IQR, 104-157 minutes) for SHIPEM patients. These figures did not vary significantly over the 6 years of the registry. In the BHH group, 180 patients (30.1%) had a symptom-to-first-door time of < or = 60 minutes, with 32 (17.8%) receiving PCI in < or = 60 minutes. The corresponding figure for the SHIPEM group was 48 patients (25.4%), with 1 (2.1%) receiving PCI within 60 minutes. In the BHH group, 304 patients (50.8%) had a symptom-to-first-door time of 61-180 minutes, with 166 (54.6%) receiving PCI in < or = 90 minutes. In the SHIPEM group, 50 patients (26.5%) had a symptom-to-first-door time of > 180 minutes, with 21 (42.0%) receiving PCI in < or = 120 minutes.
Our study demonstrates that transfer for PCI is feasible and safe in selected patients, with outcomes comparable to those of patients presenting to a PCI-capable unit. However, the CSANZ/NHFA targets, predicated by symptom-to-first-door time, are not being met and have not improved over time, which suggests that strategies to improve symptom-to-first-door, first-door-to-balloon and transfer times need to be addressed.
比较在具有直接经皮冠状动脉介入治疗（PCI）能力的医院就诊的 ST 段抬高型心肌梗死（STEMI）患者与从非 PCI 能力单位转来的患者的临床结局，并确定符合 STEMI 管理临床指南的成功率。
设计、地点和参与者：2002 年 7 月 1 日至 2008 年 6 月 30 日期间，在墨尔本 Box Hill 医院（BHH）接受 PCI 的 STEMI 患者的前瞻性研究。我们比较了两组患者：“BHH 患者”，他们直接入住 BHH（具有 PCI 能力的医院）；和“SHIPEM（东墨尔本原发性经皮冠状动脉成形术转移梗死登记处）患者”，他们从没有 PCI 能力的其他医院转来。
临床结局；症状至首次就诊时间（症状发作至首次就诊的时间）；首次就诊至球囊充气时间（首次就诊至球囊充气的时间）；符合澳大利亚心脏协会/新南威尔士州心脏基金会（CSANZ/NHFA）STEMI 患者管理指南。
BHH 组有 598 例患者，SHIPEM 组有 189 例患者。BHH 患者的中位首次就诊至球囊充气时间为 89 分钟（四分位距 [IQR]，69-107 分钟），SHIPEM 患者为 128 分钟（IQR，104-157 分钟）。这些数字在注册的 6 年中没有显著变化。在 BHH 组中，180 例（30.1%）患者的症状至首次就诊时间<或=60 分钟，32 例（17.8%）在<或=60 分钟内接受 PCI。SHIPEM 组的相应数字为 48 例（25.4%），其中 1 例（2.1%）在 60 分钟内接受 PCI。在 BHH 组中，304 例（50.8%）患者的症状至首次就诊时间为 61-180 分钟，166 例（54.6%）在<或=90 分钟内接受 PCI。在 SHIPEM 组中，50 例（26.5%）患者的症状至首次就诊时间>180 分钟，21 例（42.0%）在<或=120 分钟内接受 PCI。
我们的研究表明，在选定的患者中，转移进行 PCI 是可行和安全的，其结果与在具有 PCI 能力的单位就诊的患者相当。然而，基于症状至首次就诊时间的 CSANZ/NHFA 目标尚未达到，并且随着时间的推移并未得到改善，这表明需要采取策略来改善症状至首次就诊、首次就诊至球囊充气和转移时间。
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