Minneapolis Heart Institute Foundation, 920 E 28th St, Ste 100, Minneapolis, MN 55407, USA.
Circulation. 2011 Oct 11;124(15):1636-44. doi: 10.1161/CIRCULATIONAHA.111.033118. Epub 2011 Sep 19.
Regional ST-segment-elevation myocardial infarction systems are being developed to improve timely access to primary percutaneous coronary intervention (PCI). System delays may diminish the mortality benefit achieved with primary PCI in ST-segment-elevation myocardial infarction patients, but the specific reasons for and clinical impact of delays in patients transferred for PCI are unknown.
This was a prospective, observational study of 2034 patients transferred for primary PCI at a single center as part of a regional ST-segment-elevation myocardial infarction system from March 2003 to December 2009. Despite long-distance transfers, 30.4% of patients (n=613) were treated in ≤ 90 minutes and 65.7% (n=1324) were treated in ≤ 120 minutes. Delays occurred most frequently at the referral hospital (64.0%, n=1298), followed by the PCI center (15.7%, n=317) and transport (12.6%, n=255). For the referral hospital, the most common reasons for delay were awaiting transport (26.4%, n=535) and emergency department delays (14.3%, n=289). Diagnostic dilemmas (median, 95.5 minutes; 25th and 75th percentiles, 72-127 minutes) and nondiagnostic initial ECGs (81 minutes; 64-110.5 minutes) led to delays of the greatest magnitude. Delays caused by cardiac arrest and/or cardiogenic shock had the highest in-hospital mortality (30.6%), in contrast with nondiagnostic initial ECGs, which, despite long treatment delays, did not affect mortality (0%). Significant variation in both the magnitude and clinical impact of delays also occurred during the transport and PCI center segments.
Treatment delays occur even in efficient systems for ST-segment-elevation myocardial infarction care. The clinical impact of specific delays in interhospital transfer for PCI varies according to the cause of the delay.
区域性 ST 段抬高型心肌梗死系统的开发旨在改善患者及时接受直接经皮冠状动脉介入治疗（PCI）的机会。系统延迟可能会降低 ST 段抬高型心肌梗死患者接受直接 PCI 治疗的死亡率获益，但患者转院接受 PCI 时延迟的具体原因及其临床影响尚不清楚。
这是一项单中心前瞻性观察性研究，共纳入 2034 例患者，这些患者是作为区域性 ST 段抬高型心肌梗死系统的一部分，于 2003 年 3 月至 2009 年 12 月期间从其他医院转院接受直接 PCI 治疗。尽管是长途转院，但仍有 30.4%（n=613）的患者在 90 分钟内得到治疗，65.7%（n=1324）的患者在 120 分钟内得到治疗。延迟最常发生在转诊医院（64.0%，n=1298），其次是 PCI 中心（15.7%，n=317）和转运（12.6%，n=255）。对于转诊医院，延迟的最常见原因是等待转运（26.4%，n=535）和急诊科延迟（14.3%，n=289）。诊断难题（中位数为 95.5 分钟；25 分位数和 75 分位数分别为 72-127 分钟）和初始非诊断性 ECG（81 分钟；64-110.5 分钟）导致了最长的治疗延迟。与初始非诊断性 ECG 不同，心脏骤停和/或心源性休克引起的延迟具有最高的院内死亡率（30.6%），尽管治疗延迟时间较长，但不会影响死亡率（0%）。在转院和 PCI 中心两个阶段，治疗延迟的幅度和临床影响也存在显著差异。
即使在 ST 段抬高型心肌梗死治疗的高效系统中，也会发生治疗延迟。患者转院接受 PCI 时的具体延迟对死亡率的影响取决于延迟的原因。
