急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗中，介入医生操作与患者转运策略的1年临床结局：REVERSE-STEMI研究结果

One-year clinical outcome of interventionalist- versus patient-transfer strategies for primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction: results from the REVERSE-STEMI study.

作者信息

Zhang Qi, Zhang Rui Yan, Qiu Jian Ping, Zhang Jun Feng, Wang Xiao Long, Jiang Li, Liao Min Lei, Zhang Jian Sheng, Hu Jian, Yang Zheng Kun, Shen Wei Feng

机构信息

Department of Cardiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Rui Jin Er Road, Shanghai, People’s Republic of China.

出版信息

Circ Cardiovasc Qual Outcomes. 2011 May;4(3):355-62. doi: 10.1161/CIRCOUTCOMES.110.958785. Epub 2011 Apr 26.

DOI:10.1161/CIRCOUTCOMES.110.958785

PMID:21521833

Abstract

BACKGROUND

Traditional reperfusion options for patients with acute ST-segment elevation myocardial infarction (STEMI) presenting to non-primary percutaneous coronary intervention (PPCI)-capable hospitals generally include onsite fibrinolytics or emergency transfer for PPCI. A third option, involving interventionalist transfer, was examined in the REVERSE-STEMI study.

METHODS AND RESULTS

A total of 334 patients with acute STEMI who presented to 5 referral hospitals with angiographic facilities but without interventionalists qualified for PPCI were randomized to receive PPCI with either an interventionalist- (n=165) or a patient-transfer (n=169) strategy. The primary end point of door-to-balloon (D2B) time and secondary end points of left ventricular ejection fraction and major adverse cardiac events (MACE) at 1-year clinical follow-up were compared between the 2 groups. Compared with the patient-transfer strategy, the interventionalist-transfer strategy resulted in a significantly shortened D2B time (median, 92 minutes versus 141 minutes; P<0.0001), with more patients having first balloon angioplasty within 90 minutes (21.2% versus 7.7%, P<0.001). This treatment strategy also was associated with higher left ventricular ejection fraction (0.60±0.07 versus 0.57±0.09, P<0.001) and improved 1-year MACE-free survival (84.8% versus 74.6%, P=0.019). Multivariate Cox proportional hazards modeling revealed that the interventionalist-transfer strategy was an independent factor for reduced risk of composite MACE (hazard ratio, 0.63; 95% CI, 0.45 to 0.88; P=0.003).

CONCLUSIONS

The interventionalist-transfer strategy for PPCI may be effective in improving the care of patients with STEMI presenting to a non-PPCI-capable hospital, particularly in a congested cosmopolitan region where patient transfers could be prolonged.

摘要

背景

对于就诊于无直接经皮冠状动脉介入治疗（PPCI）能力医院的急性ST段抬高型心肌梗死（STEMI）患者，传统的再灌注选择通常包括就地溶栓或紧急转运至可行PPCI的医院。在REVERSE - STEMI研究中对第三种选择，即介入医生转运进行了研究。

方法与结果

共有334例急性STEMI患者就诊于5家具备血管造影设备但无介入医生的转诊医院，这些患者符合PPCI条件，被随机分为接受介入医生转运（n = 165）或患者转运（n = 169）策略的PPCI组。比较两组的主要终点门球时间（D2B）以及1年临床随访时的次要终点左心室射血分数和主要不良心脏事件（MACE）。与患者转运策略相比，介入医生转运策略使D2B时间显著缩短（中位数，92分钟对141分钟；P<0.0001），更多患者在90分钟内进行首次球囊血管成形术（21.2%对7.7%，P<0.001）。该治疗策略还与更高的左心室射血分数（0.60±0.07对0.57±0.09，P<0.001）和改善的1年无MACE生存率（84.8%对74.6%，P = 0.019）相关。多变量Cox比例风险模型显示，介入医生转运策略是降低复合MACE风险的独立因素（风险比，0.63；95%CI，0.45至0.88；P = 0.003）。