Department of Cardiac Services, Royal Columbian Hospital, New Westminster, British Columbia, Canada.
Can J Cardiol. 2011 Sep-Oct;27(5):664.e1-8. doi: 10.1016/j.cjca.2010.12.050. Epub 2011 Jul 31.
Primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) presents challenges in a large geographic area for achieving treatment time targets and creates demands on the PCI centre resources.
We compare the in-hospital mortality rate of patients presenting with STEMI and referred for PCI from 11 transfer hospitals with those presenting to the cardiac centre in a regional STEMI program with a selective repatriation strategy.
Between June 1, 2003, and June 30, 2007, clinical and procedural data of all STEMI patients who were referred to the catheterization laboratory were prospectively collected. Patients who sustained prolonged cardiac arrest were excluded.
A total of 1154 patients from regional hospitals and 325 patients initially presenting to the PCI centre were referred for acute intervention. There was no significant in-hospital mortality difference between the 2 groups (3.7% vs 4.0%, respectively; P = 0.87). Multiple logistic regression analysis showed that advanced age, female gender, multivessel coronary disease, history of hypertension, low ejection fraction, increased left ventricular end-diastolic pressure, and thrombolytic pretreatment, but not transfer status, were independent predictors for mortality. Among the 1154 transfer patients, 937 patients (81.2%) returned immediately post procedure and had a lower mortality rate than the remaining 217 patients (18.2%) who required admission to the PCI centre following cardiac catheterization (1.9% vs 11.5%, P < 0.001).
A regional system of STEMI care based on rapid patient transfer to a PCI centre and repatriation was feasible and safe.
对于大面积地域而言，经皮冠状动脉介入治疗（PCI）治疗 ST 段抬高型心肌梗死（STEMI）存在实现治疗时间目标的挑战，并且对 PCI 中心资源提出了要求。
我们比较了从 11 家转院医院转诊行 PCI 的 STEMI 患者与区域 STEMI 项目中心脏病中心的选择性遣返策略中 STEMI 患者的住院死亡率。
2003 年 6 月 1 日至 2007 年 6 月 30 日，前瞻性收集了所有转诊至导管室的 STEMI 患者的临床和手术数据。排除持续长时间心脏骤停的患者。
共有来自区域医院的 1154 例患者和 325 例最初在 PCI 中心就诊的患者被转诊行急性介入治疗。两组之间无显著住院死亡率差异（分别为 3.7%和 4.0%；P=0.87）。多因素逻辑回归分析显示，高龄、女性、多支冠状动脉疾病、高血压病史、射血分数降低、左心室舒张末期压升高和溶栓预处理是死亡率的独立预测因素，而非转诊状态。在 1154 例转院患者中，937 例（81.2%）在手术后立即返回，死亡率低于其余 217 例（18.8%）需要在心脏导管插入术后入住 PCI 中心的患者（1.9%比 11.5%；P<0.001）。
基于快速将患者转移至 PCI 中心和遣返的区域 STEMI 护理系统是可行且安全的。
