Adams George, Abusaid Ghassan, Lee Benjamin, Maynard Charles, Campbell Paul, Wagner Galen, Barbagelata Alejandro
Duke Clinical Research Institute, Cardiology Division-Internal Medicine, 2400 Pratt Street, Room 0306 Terrace Level, Durham, NC 27705, USA.
J Invasive Cardiol. 2010 Nov;22(11):520-5.
Percutaneous coronary intervention for ST-elevation myocardial infarction (STEMI) reduces morbidity and mortality if performed rapidly. We examined whether timely intervention in myocardial perfusion times achieved at NorthEast Medical Center (NEMC) using pre-hospital (PH) electrocardiography (ECG) could be maintained during a 3-year follow-up period, and whether a similar system could be implemented at 6 other larger hospitals in a prospective, multicenter study.
We calculated median door-to-reperfusion times for emergency medical services (EMS) and self-transport patients. PH wireless ECG transmission was attempted by trained EMS personnel with transmission to an on-call cardiologist's hand-held device. A standardized "STEMI code system" was implemented to further improve door-to-reperfusion times.
At NEMC, door-to-reperfusion times were similar in both the pilot study and follow-up periods, with a median time of 63 minutes. However, successful PH-ECG transmission was less frequent during the followup period (20% vs. 56%; p < 0.0001). At the 6 larger sites, both EMS and self-transport patients had lower door-to-reperfusion times in the study period compared to the pre-study period. However, successful PH-ECG transmission was rare in the EMS-transported patients (2%).
Initial reduction of reperfusion time at NEMC using PH-ECG transmission to the cardiologist was maintained over time, however, there was a decrease in the PH-ECG transmission rate. PHECG transmission was difficult to achieve in larger-sized communities. Successful PH-ECG transmission to an on-call cardiologist, together with an effective STEMI code system, can markedly reduce door-to-reperfusion times.
对于ST段抬高型心肌梗死（STEMI），如果能迅速进行经皮冠状动脉介入治疗，可降低发病率和死亡率。我们研究了在东北医疗中心（NEMC）通过院前（PH）心电图（ECG）实现的心肌灌注时间的及时干预在3年随访期内是否能够维持，以及在一项前瞻性多中心研究中，类似的系统能否在其他6家更大的医院实施。
我们计算了紧急医疗服务（EMS）患者和自行就诊患者的中位门到再灌注时间。训练有素的EMS人员尝试进行PH无线ECG传输，并将其传输到值班心脏病专家的手持设备上。实施了标准化的“STEMI编码系统”以进一步缩短门到再灌注时间。
在NEMC，试点研究期和随访期的门到再灌注时间相似，中位时间为63分钟。然而，随访期间成功的PH-ECG传输频率较低（20%对56%；p<0.0001）。在6个更大的地点，与研究前相比，研究期间EMS患者和自行就诊患者的门到再灌注时间都更短。然而，在EMS运送的患者中，成功的PH-ECG传输很少见（2%）。
在NEMC，通过向心脏病专家传输PH-ECG最初实现的再灌注时间缩短随着时间的推移得以维持，然而，PH-ECG传输率有所下降。在较大的社区中，PH-ECG传输很难实现。成功地向值班心脏病专家传输PH-ECG，再加上有效的STEMI编码系统，可以显著缩短门到再灌注时间。
