Acquisto Nicole M, Hays Daniel P, Fairbanks Rollin J Terry, Shah Manish N, Delehanty Joseph, Nobay Flavia, Guido Joseph, Haas Curtis E
Department of Pharmacy, University of Rochester Medical Center, Rochester, NY, USA.
J Emerg Med. 2012 Apr;42(4):371-8. doi: 10.1016/j.jemermed.2010.06.011. Epub 2010 Sep 2.
Current guidelines recommend door-to-balloon times of 90 min or less for patients presenting to the emergency department (ED) with ST-segment elevation myocardial infarction (STEMI).
To determine if a clinical pharmacist for the ED (EPh) is associated with decreased door/diagnosis-to-cardiac catheterization laboratory (CCL) time and decreased door-to-balloon time.
A retrospective observational cohort study of ED patients with STEMI requiring urgent cardiac catheterization was conducted. Blinded data collection included timing of ED and CCL arrival, diagnostic electrocardiogram (ECG), and balloon angioplasty. For cases diagnosed after ED arrival, diagnosis time was substituted for door time. Diagnosis was the time ST elevations were evident on serial ECG. EPh present and not-present groups were compared. During the study period there were two EPhs and presence was determined by their scheduled time in the ED. Univariate and multivariate analyses was used to detect differences.
Multivariate analysis of 120 patients, controlled for CCL staff presence and arrival by pre-hospital services, determined that EPh presence is associated with a mean 13.1-min (95% confidence interval [CI] 6.5-21.9) and 11.5-min (95% CI 3.9-21.5) decrease in door/diagnosis-to-CCL and door-to-balloon times, respectively. Patients were more likely to achieve a door/diagnosis-to-CCL time≤ 30 min (odds ratio [OR] 3.1, 95% CI 1.3-7.8) and≤ 45 min (OR 2.9, 95% CI-1.0, 8.5) and a door-to-balloon time≤ 90 min (OR 1.9, 95% CI 0.7-5.5) more likely when the EPh was present.
EPh presence during STEMI presentation to the ED is independently associated with a decrease in door/diagnosis-to-CCL and door-to-balloon times.
当前指南建议，对于因ST段抬高型心肌梗死（STEMI）就诊于急诊科（ED）的患者，门球时间应在90分钟或更短。
确定急诊科临床药师（EPh）是否与缩短门/诊断至心导管实验室（CCL）时间及门球时间相关。
对需要紧急心导管插入术的STEMI急诊患者进行回顾性观察队列研究。盲法数据收集包括急诊科和CCL到达时间、诊断性心电图（ECG）及球囊血管成形术时间。对于在到达急诊科后确诊的病例，用诊断时间代替门时间。诊断时间为系列心电图上ST段抬高明显的时间。比较有EPh在场组和无EPh在场组。在研究期间有两名EPh，根据他们在急诊科的排班时间确定是否在场。采用单因素和多因素分析来检测差异。
对120例患者进行多因素分析，控制CCL工作人员在场情况及院前服务到达时间后，确定EPh在场分别与门/诊断至CCL时间平均缩短13.1分钟（95%置信区间[CI] 6.5 - 21.9）及门球时间平均缩短11.5分钟（95% CI 3.9 - 21.5）相关。当EPh在场时，患者更有可能实现门/诊断至CCL时间≤30分钟（优势比[OR] 3.1，95% CI 1.3 - 7.8）和≤45分钟（OR 2.9，95% CI 1.0 - 8.5），以及门球时间≤90分钟（OR 1.9，95% CI 0.7 - 5.5）。
STEMI患者在急诊科就诊时EPh在场与门/诊断至CCL时间及门球时间缩短独立相关。
