Department of Internal Medicine, Division of Cardiology, Virginia Commonwealth University, Richmond, VA 23298-0051, USA.
Am J Emerg Med. 2011 Oct;29(8):868-74. doi: 10.1016/j.ajem.2010.03.025. Epub 2010 May 1.
We evaluated the impact of emergency physician (EP)-initiated primary percutaneous coronary intervention (PCI) via a single-group page on door to balloon (D2B) interval times in patients with ST-segment elevation myocardial infarction.
Consecutive ST-segment elevation myocardial infarction patients presenting to the emergency department between February 2004 and September 2008 were divided into 4 groups: group 1, PCI performed on an ad hoc basis after cardiology consultation; group 2, primary PCI activated via a single-group page only on-call cardiology consultation; group 3, primary PCI with EP cardiac catheterization laboratory (CCL) activation via the same page strategy; group 4, prehospital CCL activation based on prehospital diagnostic electrocardiogram. Composite D2B and relevant time intervals were measured for each time group.
A total of 295 consecutive patients undergoing emergent angiography were included. Times decreased for most time intervals from groups 1 to 4. Although there was no significant change in composite D2B or any measured interval time with the introduction of PCI after emergent cardiology consultation, each decreased significantly after implementing an EP-initiated PCI strategy except CCL2B (D2B 95 to 77 minutes, D2E 14 to 10 minutes, D2CCL 71 to 50 minutes). Further significant reductions in D2B time were achieved among all patients after the institution of emergency medicine services activation of the CCL (D2B 77 to 64 minutes, D2CCL 50 to 38 minutes, CCL2B 28 to 22 minutes).
A systematic process of initiating D2B recommendations, including EP-initiated CCL activation via a single-group page, significantly reduces D2CCL and D2B times.
我们通过单页群呼的方式评估急诊医师（EP）启动的直接经皮冠状动脉介入治疗（PCI）对 ST 段抬高型心肌梗死患者门球时间（D2B）的影响。
2004 年 2 月至 2008 年 9 月连续就诊于急诊科的 ST 段抬高型心肌梗死患者分为 4 组：组 1，心内科会诊后进行择期 PCI；组 2，仅通过单页群呼心内科会诊启动直接 PCI；组 3，通过同一页策略启动 EP 心导管室（CCL）激活的直接 PCI；组 4，基于院前诊断心电图的院前 CCL 激活。每组测量复合 D2B 和相关时间间隔。
共纳入 295 例接受紧急血管造影的连续患者。大多数时间间隔的时间从组 1 到组 4 都减少了。尽管在紧急心内科会诊后行 PCI 引入后，复合 D2B 或任何测量的间隔时间没有显著变化，但实施 EP 启动的 PCI 策略后，除 CCL2B 外，所有间隔时间都显著减少（D2B 从 95 分钟减少至 77 分钟，D2E 从 14 分钟减少至 10 分钟，D2CCL 从 71 分钟减少至 50 分钟）。在启动急诊医学服务激活 CCL 后，所有患者的 D2B 时间进一步显著减少（D2B 从 77 分钟减少至 64 分钟，D2CCL 从 50 分钟减少至 38 分钟，CCL2B 从 28 分钟减少至 22 分钟）。
启动 D2B 建议的系统过程，包括通过单页群呼启动 EP 激活 CCL，可显著减少 D2CCL 和 D2B 时间。
