Levis Joel T, Mercer Mary P, Thanassi Mark, Lin James
Perm J. 2010 Fall;14(3):4-11. doi: 10.7812/TPP/10.977.
Prompt percutaneous coronary intervention (PCI) for patients with ST-segment elevation myocardial infarction (STEMI) can significantly reduce mortality and morbidity, although its effectiveness may be limited by delays in delivery. In March 2008, our hospital implemented a Heart Alert protocol to rapidly identify and treat patients with STEMI presenting to our Emergency Department (ED) with PCI, using strategies previously described to reduce door-to-balloon times. Before the Heart Alert protocol start date, patients with STEMI presenting to our ED were treated with thrombolysis.
We evaluated data from patients with STEMI after one year of use of our Heart Alert protocol to determine protocol success on the basis of the percentage of patients for whom the recommended door-to-balloon times of ≤90 minutes were met. We examined factors involved in implementation of the protocol that contributed to these results.
We conducted a retrospective data and chart review for patients in the ED with STEMI who underwent PCI after a Heart Alert protocol activation between March 17, 2008, and March 17, 2009.
During the study period, our staff met the recommended door-to-balloon time of ≤90 minutes (mean door-to-balloon time, 57.3 ± 17.6 minutes) for 70 of 72 patients (97%) presenting to our ED with STEMI. Sixty-five of the 72 patients (90.3%) survived to hospital discharge.
Initiation of a Heart Alert protocol at our hospital resulted in achievement of door-to-balloon times of ≤90 minutes for 97% of patients with STEMI. This achievement was obtained through careful preparation, training, and interdepartmental collaboration and occurred despite immediate conversion from a previous thrombolytic protocol.
对于ST段抬高型心肌梗死（STEMI）患者，及时进行经皮冠状动脉介入治疗（PCI）可显著降低死亡率和发病率，尽管其有效性可能会受到治疗延迟的限制。2008年3月，我院实施了一项心脏警报方案，采用先前描述的策略来缩短球囊扩张时间，以快速识别并治疗在急诊科（ED）就诊的STEMI患者。在心脏警报方案开始实施之前，在我院急诊科就诊的STEMI患者接受溶栓治疗。
我们评估了心脏警报方案使用一年后STEMI患者的数据，以根据达到推荐的球囊扩张时间≤90分钟的患者百分比来确定方案的成功率。我们研究了方案实施过程中促成这些结果的相关因素。
我们对2008年3月17日至2009年3月17日期间在心脏警报方案启动后接受PCI的急诊科STEMI患者进行了回顾性数据和病历审查。
在研究期间，对于我院急诊科72例STEMI患者中的70例（97%），我们的工作人员达到了推荐的球囊扩张时间≤90分钟（平均球囊扩张时间为57.3±17.6分钟）。72例患者中有65例（90.3%）存活至出院。
我院启动心脏警报方案后，97%的STEMI患者实现了球囊扩张时间≤90分钟。这一成果是通过精心准备、培训和部门间协作取得的，尽管之前立即从溶栓方案转变而来。
