Cornell University, Division of Cardiology, Department of Medicine, Weill Medical College, New York, New York, USA.
Catheter Cardiovasc Interv. 2012 May 1;79(6):851-8. doi: 10.1002/ccd.23221. Epub 2011 Dec 12.
To assess a quality improvement initiative aimed at minimizing door-to-balloon (DTB) times for ST-elevation myocardial infarction (STEMI) patients presenting without chest pain.
Timely percutaneous coronary intervention (PCI) is the cornerstone of STEMI care. The absence of chest pain delays PCI. Improvements in DTB times may need to focus on atypical presentation patients.
We compared DTB times on all STEMI patients admitted through the emergency department who underwent PCI before (Phase I; October 2004-June 2007) and after (Phase II; July 2007-October 2009) the quality improvement effort, which mandated rapid electrocardiogram (ECG) triage for an expanded list of presenting symptoms.
In Phase I (69 patient, 60 with chest pain), patients with chest pain had a shorter mean time to first ECG (ECG Interval) by 32.0 min (P < 0.01) and nonsignificantly faster mean DTB time by 42.0 min (P = 0.07) compared to patients who presented without chest pain. In Phase II (62 patients, 56 with chest pain) compared to Phase I, mean ECG interval decreased by 44 min (P = 0.02) and mean DTB time by 99 min (P = 0.01) in patients without chest pain, eliminating the differences in ECG intervals between typical and atypical presentations (12 min vs. 11 min, P = 0.91). Multivariable analysis controlling for on/off hours and patient characteristics confirmed these findings.
A simple modification of emergency room ECG triage protocol, which expands indications for rapid ECG performance, was successful in improving rapid reperfusion for patients with STEMI presenting without chest pain.
评估一项旨在尽量缩短无胸痛 ST 段抬高型心肌梗死（STEMI）患者门球时间（DTB）的质量改进计划。
及时进行经皮冠状动脉介入治疗（PCI）是 STEMI 治疗的基石。无胸痛会延迟 PCI。DTB 时间的改善可能需要侧重于非典型表现的患者。
我们比较了通过急诊科收治并接受 PCI 的所有 STEMI 患者的 DTB 时间，这些患者在质量改进努力之前（第 I 阶段；2004 年 10 月至 2007 年 6 月）和之后（第 II 阶段；2007 年 7 月至 2009 年 10 月），该质量改进计划要求对更广泛的症状表现进行快速心电图（ECG）分类。
在第 I 阶段（69 例患者，60 例有胸痛）中，有胸痛的患者首次心电图（ECG 间隔）的平均时间缩短了 32.0 分钟（P < 0.01），而无胸痛的患者的 DTB 时间平均缩短了 42.0 分钟（P = 0.07），但无统计学意义。在第 II 阶段（62 例患者，56 例有胸痛）与第 I 阶段相比，无胸痛患者的平均 ECG 间隔减少了 44 分钟（P = 0.02），平均 DTB 时间减少了 99 分钟（P = 0.01），消除了典型和非典型表现之间 ECG 间隔的差异（12 分钟对 11 分钟，P = 0.91）。多变量分析控制了开/关时间和患者特征，证实了这些发现。
对急诊室 ECG 分类方案的简单修改，扩大了快速 ECG 检查的适应证，成功地改善了无胸痛 STEMI 患者的快速再灌注。
