Song Li, Yan Hong-bing, Yang Jin-gang, Sun Yi-hong, Liu Shu-shan, Li Chao, Hu Da-yi
28th Division, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2010 Apr;38(4):301-5.
To determine lengths and factors associated with delay of reperfusion-decision in patients with acute ST-segment elevation myocardial infarction (STEMI).
This cross-sectional and multicenter survey was conducted in 19 hospitals from Beijing between 1 January and 31 December, 2006 and included STEMI patients receiving thrombolysis or primary percutaneous coronary intervention (PCI). Data were collected by structured interviews and medical records review within 1 week after admission. Reperfusion-decision delay was defined as time interval from the initial ECG after admission to sign of the thrombolysis or operation approval. Patients were categorized into an early decision group and a late decision group based on the 30 min cut-off time.
Of the 635 STEMI patients interviewed, 129 (20.3%) received thrombolysis, and the remaining 506 (79.7%) received primary PCI. The median reperfusion-decision delay was 47 min. The median door-to-needle time was 82 min, and the median door-to-balloon time was 135 min. Multivariate logistic analysis showed that awareness of the time-dependent nature of reperfusion therapy (OR = 1.723, 95% CI: 1.156-3.212, P = 0.040), pre-hospital electrocardiogram (OR = 1.566, 95% CI: 1.018-2.409, P = 0.036), cardiac function of Killip > or = 2 at admission (OR = 1.579, 95% CI: 1.004-2.483, P = 0.021) and presenting to cardiovascular specialty hospital (OR = 5.075, 95% CI: 1.380-18.655, P = 0.014) were independent predictors early reperfusion-decision delay. Patients in early decision group had significantly shorter median door-to-needle (47 vs. 103 min, P < 0.001) and door-to-balloon (100 vs. 154 min, P < 0.001) times compared to patients in late decision group.
The main reason of the in-hospital delay of reperfusion therapy of STEMI patients is reperfusion-decision delay. New public health strategies should be developed to educate patients and their family members to increase their awareness of the importance and benefits of prompt reperfusion therapy and facilitate the pre-hospital electrocardiogram recording for STEMI patients.
确定急性ST段抬高型心肌梗死（STEMI）患者再灌注决策延迟的时长及相关因素。
这项横断面多中心调查于2006年1月1日至12月31日在北京的19家医院进行，纳入接受溶栓或直接经皮冠状动脉介入治疗（PCI）的STEMI患者。入院1周内通过结构化访谈和查阅病历收集数据。再灌注决策延迟定义为从入院后首次心电图至溶栓或手术批准迹象的时间间隔。根据30分钟的截止时间将患者分为早期决策组和晚期决策组。
在接受访谈的635例STEMI患者中，129例（20.3%）接受了溶栓治疗，其余506例（79.7%）接受了直接PCI。再灌注决策延迟的中位数为47分钟。门到针时间的中位数为82分钟，门到球囊时间的中位数为135分钟。多因素逻辑分析显示，对再灌注治疗时间依赖性的认识（OR = 1.723，95%CI：1.156 - 3.212，P = 0.040）、院前心电图（OR = 1.566，95%CI：1.018 - 2.409，P = 0.036）、入院时Killip分级>或=2级的心功能（OR = 1.579，95%CI：1.004 - 2.483，P = 0.021）以及就诊于心血管专科医院（OR = 5.075，95%CI：1.380 - 18.655，P = 0.014）是早期再灌注决策延迟的独立预测因素。与晚期决策组患者相比，早期决策组患者的门到针时间中位数（47分钟对103分钟，P < 0.001）和门到球囊时间中位数（100分钟对154分钟，P < 0.001）明显更短。
STEMI患者院内再灌注治疗延迟的主要原因是再灌注决策延迟。应制定新的公共卫生策略，对患者及其家属进行教育，以提高他们对及时再灌注治疗重要性和益处的认识，并促进STEMI患者的院前心电图记录。
