Song Li, Yan Hong-bing, Yang Jin-gang, Sun Yi-hong, Li Chao
28th Division, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2010 May;38(5):406-10.
To examine the present situation of inter-hospital transfer and its impact on early reperfusion therapies and short-term outcomes in patients with acute ST-elevation myocardial infarction (STEMI) in Beijing.
This cross-sectional and multicenter survey was conducted between 1 January and 31 December, 2006. A total of 789 STEMI patients admitted within 24 h of symptom onset to 19 hospitals capable of performing primary percutaneous coronary intervention (PCI) in Beijing were divided into transfer group and non-transfer group. Data were collected by structured interviews and medical records review.
A total of 236 STEMI patients (29.9%) experienced inter-hospital transfer. Of these, 76.7% were transferred from primary and secondary hospitals to tertiary hospitals, 22.9% were transferred from tertiary hospitals to tertiary hospitals, 67.4% were transferred from non-primary PCI centers to primary PCI centers, 32.6% were transferred from primary PCI centers to primary PCI centers. The difference of primary PCI rate (62.7% vs. 66.4%, P = 0.328) and door to balloon time (median, 132 min vs.135 min, P = 0.473) were similar between 2 groups. The symptom onset to balloon time was significantly longer in transfer group than in non-transfer group (median, 397 min vs. 246 min, P < 0.001). The in-hospital mortality was similar between 2 groups (4.7% vs.5.8%, P = 0.609).
The present situation of inter-hospital transfer is complicated for STEMI patients in Beijing. Inter-hospital transfer prolonged symptom onset to balloon time but did not influence primary PCI rate and door to balloon time as well as the short-term outcomes. Regional STEMI networks need to be instituted to improve therapies for STEMI patients.
探讨北京地区急性ST段抬高型心肌梗死（STEMI）患者院际转运的现状及其对早期再灌注治疗和短期预后的影响。
本横断面多中心调查于2006年1月1日至12月31日进行。将北京地区19家能够开展直接经皮冠状动脉介入治疗（PCI）的医院中，症状发作24小时内入院的789例STEMI患者分为转运组和非转运组。通过结构化访谈和查阅病历收集数据。
共有236例STEMI患者（29.9%）经历了院际转运。其中，76.7%从基层医院和二级医院转入三级医院，22.9%从三级医院转入三级医院，67.4%从非直接PCI中心转入直接PCI中心，32.6%从直接PCI中心转入直接PCI中心。两组之间直接PCI率（62.7%对66.4%，P = 0.328）和门球时间（中位数，132分钟对135分钟，P = 0.473）差异相似。转运组症状发作至球囊扩张时间显著长于非转运组（中位数，397分钟对246分钟，P < 0.001）。两组院内死亡率相似（4.7%对5.8%，P = 0.609）。
北京地区STEMI患者院际转运情况复杂。院际转运延长了症状发作至球囊扩张时间，但不影响直接PCI率、门球时间及短期预后。需要建立区域性STEMI网络以改善STEMI患者的治疗。
