Department of Cardiology, Aarhus University Hospital, DK-8200 Aarhus N, Denmark.
JAMA. 2010 Aug 18;304(7):763-71. doi: 10.1001/jama.2010.1139.
Timely reperfusion therapy is recommended for patients with ST-segment elevation myocardial infarction (STEMI), and door-to-balloon delay has been proposed as a performance measure in triaging patients for primary percutaneous coronary intervention (PCI). However, focusing on the time from first contact with the health care system to the initiation of reperfusion therapy (system delay) may be more relevant, because it constitutes the total time to reperfusion modifiable by the health care system. No previous studies have focused on the association between system delay and outcome in patients with STEMI treated with primary PCI.
To evaluate the associations between system, treatment, patient, and door-to-balloon delays and mortality in patients with STEMI.
DESIGN, SETTING, AND PATIENTS: Historical follow-up study based on population-based Danish medical registries of patients with STEMI transported by the emergency medical service and treated with primary PCI from January 1, 2002, to December 31, 2008, at 3 high-volume PCI centers in Western Denmark. Patients (N = 6209) underwent primary PCI within 12 hours of symptom onset. The median follow-up time was 3.4 (interquartile range, 1.8-5.2) years.
Crude and adjusted hazard ratios of mortality obtained by Cox proportional regression analysis.
A system delay of 0 through 60 minutes (n = 347) corresponded to a long-term mortality rate of 15.4% (n = 43); a delay of 61 through 120 minutes (n = 2643) to a rate of 23.3% (n = 380); a delay of 121 through 180 minutes (n = 2092) to a rate of 28.1% (n = 378); and a delay of 181 through 360 minutes (n = 1127) to a rate of 30.8% (n = 275) (P < .001). In multivariable analysis adjusted for other predictors of mortality, system delay was independently associated with mortality (adjusted hazard ratio, 1.10 [95% confidence interval, 1.04-1.16] per 1-hour delay), as was its components, prehospital system delay and door-to-balloon delay.
System delay was associated with mortality in patients with STEMI treated with primary PCI.
对于 ST 段抬高型心肌梗死（STEMI）患者，建议进行及时再灌注治疗，而门球时间延迟已被提议作为对行直接经皮冠状动脉介入治疗（PCI）的患者进行分诊的一项绩效指标。然而，关注从首次接触医疗保健系统到开始再灌注治疗的时间（系统延迟）可能更为相关，因为这构成了可通过医疗保健系统改变的总再灌注时间。以前的研究都没有关注 STEMI 患者接受直接 PCI 治疗时系统延迟与结局之间的关系。
评估 STEMI 患者的系统、治疗、患者和门球时间延迟与死亡率之间的关系。
设计、地点和患者：基于丹麦西部 3 家高容量 PCI 中心于 2002 年 1 月 1 日至 2008 年 12 月 31 日期间，通过急诊医疗服务转运并接受直接 PCI 治疗的 STEMI 患者的基于人群的丹麦医学登记处的历史随访研究。患者（N=6209）在症状发作后 12 小时内行直接 PCI。中位随访时间为 3.4 年（四分位距，1.8-5.2 年）。
通过 Cox 比例风险回归分析获得的死亡率的粗和调整后危险比。
0-60 分钟的系统延迟（n=347）对应于长期死亡率为 15.4%（n=43）；61-120 分钟的延迟（n=2643）对应于 23.3%（n=380）的死亡率；121-180 分钟的延迟（n=2092）对应于 28.1%（n=378）的死亡率；181-360 分钟的延迟（n=1127）对应于 30.8%（n=275）的死亡率（P<.001）。在调整其他死亡率预测因素后进行的多变量分析中，系统延迟与死亡率独立相关（调整后危险比，每延迟 1 小时 1.10[95%置信区间，1.04-1.16]），其组成部分，院前系统延迟和球囊扩张时间延迟也是如此。
在接受直接 PCI 治疗的 STEMI 患者中，系统延迟与死亡率相关。
