Lubovich Alla, Hamood Hatem, Behar Solomon, Rosenschein Uri
Department of Cardiology, Bnai Zion Medical Center, Haifa, Israel.
Isr Med Assoc J. 2011 Apr;13(4):216-9.
Rapid reperfusion of an infarct-related artery is crucial for the successful treatment of ST elevation myocardial infarction. Every effort should be made to shorten door-to-balloon time.
To investigate whether bypassing the emergency room (ER) has a positive influence on door-to-balloon time in patients presenting with ST elevation myocardial infarction (STEMI) and whether the reduction in door-to-balloon time improves patients' clinical outcome.
We analyzed data of 776 patients with STEMI from the 2004 and the 2006 Acute Coronary Syndrome Israeli Survey (ACSIS) registry. The ACSIS is a biennial survey on acute myocardial infarction performed in all 25 intensive cardiac care units in Israel during a 2-month period. Twenty-five percent of patients (193 of 776) arrived directly to the intensive cardiac care unit (ICCU) and 75% (583 of 776) were assessed first in the ER. We compared door-to-balloon time, ejection fraction, 30 days MACE (major adverse cardiac and cerebrovascular events) and 30 days mortality in the two study groups.
There was significantly shorter door-to-balloon time in the direct ICCU group as compared with the ER group (45 vs. 79 minutes, P< 0.002). Patients in the direct ICCU group were more likely to have door-to-balloon time of less than 90 minutes in accordance with ACC/AHA guidelines (88.7% vs. 59.2%, P < 0.0001). Moreover, patients in the direct ICCU group were less likely to have left ventricular ejection fraction < 30% (5.4% vs. 12.2%, P= 0.045) and less likely to have symptoms of overt congestive heart failure. Lastly, 30 days MACE was significantly lower in the direct ICCU group (22 vs. 30%, P< 0.004).
There is significant reduction of the door-to-balloon time in the direct ICCU admission strategy. This reduction translates into improvement in clinical outcome of patients. It is reasonable to apply the direct ICCU strategy to patients with STEMI.
梗死相关动脉的快速再灌注对于ST段抬高型心肌梗死的成功治疗至关重要。应尽一切努力缩短门球时间。
调查绕过急诊室（ER）对ST段抬高型心肌梗死（STEMI）患者的门球时间是否有积极影响，以及门球时间的缩短是否能改善患者的临床结局。
我们分析了2004年和2006年以色列急性冠状动脉综合征调查（ACSIS）登记处的776例STEMI患者的数据。ACSIS是一项对以色列所有25个重症心脏监护病房在2个月期间进行的急性心肌梗死的两年一次的调查。25%的患者（776例中的193例）直接到达重症心脏监护病房（ICCU），75%（776例中的583例）首先在急诊室接受评估。我们比较了两个研究组的门球时间、射血分数、30天主要不良心脏和脑血管事件（MACE）以及30天死亡率。
与急诊室组相比，直接ICCU组的门球时间明显更短（45分钟对79分钟，P<0.002）。根据美国心脏病学会/美国心脏协会（ACC/AHA）指南，直接ICCU组的患者门球时间少于90分钟的可能性更大（88.7%对59.2%，P<0.0001）。此外，直接ICCU组的患者左心室射血分数<30%的可能性较小（5.4%对12.2%，P=0.045），出现明显充血性心力衰竭症状的可能性也较小。最后，直接ICCU组的30天MACE明显更低（22%对30%，P<0.004）。
直接ICCU入院策略可显著缩短门球时间。这种缩短转化为患者临床结局的改善。对STEMI患者应用直接ICCU策略是合理的。
