质量指标研究：降低ST段抬高型心肌梗死患者门球时间的进展

Quality measure study: progress in reducing the door-to-balloon time in patients with ST-segment elevation myocardial infarction.

作者信息

Nishida Katsufumi, Hirota Sean K, Seto Todd B, Smith Daniel C, Young Cathy, Muranaka Wanda, Beauvallet Suzanne, Fergusson David

机构信息

John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii 96813, USA.

出版信息

Hawaii Med J. 2010 Oct;69(10):242-6.

PMID:21229488

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3071180/

Abstract

BACKGROUND

Reperfusion therapy improves both mortality and morbidity in patients with ST-elevation myocardial infarction (STEMI). Timeliness of such reperfusion is an important factor in improving patient survival. For percutaneous coronary intervention (PCI), the American College of Cardiology has recommended a goal of <90 minutes from initial hospital contact to first balloon inflation.

METHODS

The authors retrospectively reviewed 131 patients with a diagnosis of STEMI seen at a PCI capable hospital between January, 2006 and September, 2008, a period of time before and after implementation of a protocol aimed at reducing door-to-balloon time. Sixty-one percent of study population was Asian or Pacific Islander. This protocol was largely based on the identification by Bradley et al. of factors whose modification could shorten this time interval.

RESULTS

Time to reperfusion was compared between groups before (n=57), and after (n=58) protocol implementation. Median door-to-balloon time for the former group was 133 minutes, interquartile range (IQRs), (25th, 75th percentile; 104.5, 147), and for the latter group 67 minutes, IQRs (56, 80) respectively (p<0.001). Prior to implementation of the protocol, a door-to-balloon time of <90 minutes was achieved in 17% of cases. By the third quarter of 2008, this goal was being met in 100%.

CONCLUSION

This observational study provides support for the use of the strategies described as a key for reduction in door-to-balloon time.

摘要

背景

再灌注治疗可改善ST段抬高型心肌梗死（STEMI）患者的死亡率和发病率。这种再灌注的及时性是提高患者生存率的重要因素。对于经皮冠状动脉介入治疗（PCI），美国心脏病学会建议从首次医院接触到首次球囊扩张的目标时间<90分钟。

方法

作者回顾性分析了2006年1月至2008年9月期间在一家具备PCI能力的医院就诊的131例STEMI患者，这是在实施一项旨在缩短门球时间的方案前后的一段时间。研究人群中61%为亚洲人或太平洋岛民。该方案主要基于布拉德利等人对那些改变后可缩短此时间间隔的因素的识别。

结果

比较了方案实施前（n = 57）和实施后（n = 58）两组的再灌注时间。前一组的中位门球时间为分钟，四分位间距（IQR）（第25、75百分位数；104.5，147），后一组为67分钟，IQR（56，80）（p<0.001）。在方案实施前，17%的病例实现了<90分钟的门球时间。到2008年第三季度，这一目标的达成率为100%。