Department of Emergency Medicine William Beaumont Hospital, Royal Oak, Michigan 48703, USA.
Prehosp Emerg Care. 2012 Jan-Mar;16(1):115-20. doi: 10.3109/10903127.2011.615012. Epub 2011 Oct 14.
To assess the relationship of emergency medical services (EMS) intervals and internal hospital intervals to the rapid reperfusion of patients with ST-segment elevation myocardial infarction (STEMI).
We performed a secondary analysis of a prospectively collected database of STEMI patients transported to a large academic community hospital between January 1, 2004, and December 31, 2009. EMS and hospital data intervals included EMS scene time, transport time, hospital arrival to myocardial infarction (MI) team activation (D2Page), page to catheterization laboratory arrival (P2Lab), and catheterization laboratory arrival to reperfusion (L2B). We used two outcomes: EMS scene arrival to reperfusion (S2B) ≤90 minutes and hospital arrival to reperfusion (D2B) ≤90 minutes. Means and proportions are reported. Pearson chi-square and multivariate regression were used for analysis.
During the study period, we included 313 EMS-transported STEMI patients with 298 (95.2%) MI team activations. Of these STEMI patients, 295 (94.2%) were taken to the cardiac catheterization laboratory and 244 (78.0%) underwent percutaneous coronary intervention (PCI). For the patients who underwent PCI, 127 (52.5%) had prehospital EMS activation, 202 (82.8%) had D2B ≤90 minutes, and 72 (39%) had S2B ≤90 minutes. In a multivariate analysis, hospital processes EMS activation (OR 7.1, 95% CI 2.7, 18.4], Page to Lab [6.7, 95% CI 2.3, 19.2] and Lab arrival to Reperfusion [18.5, 95% CI 6.1, 55.6]) were the most important predictors of Scene to Balloon ≤ 90 minutes. EMS scene and transport intervals also had a modest association with rapid reperfusion (OR 0.85, 95% CI 0.78, 0.93 and OR 0.89, 95% CI 0.83, 0.95, respectively). In a secondary analysis, Hospital processes (Door to Page [OR 44.8, 95% CI 8.6, 234.4], Page 2 Lab [OR 5.4, 95% CI 1.9, 15.3], and Lab arrival to Reperfusion [OR 14.6 95% CI 2.5, 84.3]), but not EMS scene and transport intervals were the most important predictors D2B ≤90 minutes.
In our study, hospital process intervals (EMS activation, door to page, page to laboratory, and laboratory to reperfusion) are key covariates of rapid reperfusion for EMS STEMI patients and should be used when assessing STEMI care.
评估急救医疗服务（EMS）时间间隔和院内时间间隔与 ST 段抬高型心肌梗死（STEMI）患者快速再灌注的关系。
我们对 2004 年 1 月 1 日至 2009 年 12 月 31 日期间转运至一家大型学术社区医院的 STEMI 患者的前瞻性收集数据库进行了二次分析。EMS 和医院数据时间间隔包括 EMS 现场时间、转运时间、医院到达 MI 团队激活（D2Page）、呼叫到导管实验室到达（P2Lab）以及导管实验室到达再灌注（L2B）。我们使用了两个结局：EMS 现场到达再灌注（S2B）≤90 分钟和医院到达再灌注（D2B）≤90 分钟。报告均值和比例。采用 Pearson 卡方检验和多变量回归进行分析。
在研究期间，我们纳入了 313 名接受 EMS 转运的 STEMI 患者，其中 298 名（95.2%）接受了 MI 团队激活。在这些 STEMI 患者中，295 名（94.2%）被送往心脏导管实验室，244 名（78.0%）接受了经皮冠状动脉介入治疗（PCI）。对于接受 PCI 的患者，127 名（52.5%）有院前 EMS 激活，202 名（82.8%）有 D2B≤90 分钟，72 名（39%）有 S2B≤90 分钟。多变量分析显示，医院流程 EMS 激活（OR 7.1，95%CI 2.7，18.4]、呼叫到实验室[6.7，95%CI 2.3，19.2]和实验室到达再灌注[18.5，95%CI 6.1，55.6]）是 S2B≤90 分钟的最重要预测因素。EMS 现场和转运时间间隔也与快速再灌注有一定的相关性（OR 0.85，95%CI 0.78，0.93 和 OR 0.89，95%CI 0.83，0.95）。在二次分析中，医院流程（门到呼叫[OR 44.8，95%CI 8.6，234.4]、呼叫到实验室[OR 5.4，95%CI 1.9，15.3]和实验室到达再灌注[OR 14.6，95%CI 2.5，84.3]），而不是 EMS 现场和转运时间间隔，是 EMS STEMI 患者快速再灌注的最重要预测因素，在评估 STEMI 护理时应予以考虑。
在我们的研究中，医院流程时间间隔（EMS 激活、门到呼叫、呼叫到实验室和实验室到再灌注）是 EMS STEMI 患者快速再灌注的关键协变量，在评估 STEMI 护理时应予以考虑。
