Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, 920 East 28th Street, Minneapolis, MN 55407, USA.
Eur Heart J. 2012 May;33(10):1232-40. doi: 10.1093/eurheartj/ehr403. Epub 2011 Oct 31.
To determine the safety and efficacy of a pharmaco-invasive reperfusion strategy utilizing half-dose fibrinolysis combined with transfer for immediate percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) patients presenting to remote rural hospitals. Primary PCI is preferred for STEMI if performed in a timely manner. However, <20% of STEMI patients transferred for PCI in the USA have door-to-balloon times <2 h.
Prospective data from the Level 1 MI programme were analysed. All STEMI patients presenting to the Minneapolis Heart Institute or 31 referral hospitals received aspirin, clopidogrel, and unfractionated heparin (UFH) at the presenting hospital and those presenting to hospitals ≥60 miles away also received half-dose fibrinolytic with transfer for immediate PCI. From April 2003 through December 2009, we enrolled 2634 consecutive STEMI patients in the Level 1 MI database including 660 transferred from remote hospitals utilizing pharmaco-invasive therapy and 600 patients who presented directly to the PCI centre. There were no significant differences in 30-day mortality (5.5 vs. 5.6%; P= 0.94), stroke (1.1 vs. 1.3%; P= 0.66) or major bleeding (1.5 vs. 1.8%; P= 0.65), or re-infarction/ischaemia (1.2 vs. 2.5%; P= 0.088) in patients receiving a pharmaco-invasive strategy compared with patients presenting directly to the PCI centre, despite a significantly longer door-to-balloon time.
Within a regional STEMI system of care, half-dose fibrinolysis combined with immediate transfer for PCI may be a safe and effective option for STEMI patients with expected delays due to long-distance transfer.
确定半剂量溶栓联合即刻转院行直接经皮冠状动脉介入治疗（PCI）在送往偏远农村医院的 ST 段抬高型心肌梗死（STEMI）患者中的安全性和有效性。对于 STEMI 患者，如果及时进行，首选直接 PCI。然而，在美国，<20%转院接受 PCI 的 STEMI 患者的门球时间<2 小时。
分析了 1 级 MI 计划的前瞻性数据。所有送往明尼阿波利斯心脏研究所或 31 家转诊医院的 STEMI 患者在就诊医院接受阿司匹林、氯吡格雷和未分级肝素（UFH）治疗，距离>60 英里的就诊医院的患者还接受半剂量溶栓联合即刻 PCI 转院治疗。2003 年 4 月至 2009 年 12 月，我们将 2634 例连续 STEMI 患者纳入 1 级 MI 数据库，包括 660 例来自偏远医院的转院患者和 600 例直接送往 PCI 中心的患者。接受药物介入治疗的转院患者和直接送往 PCI 中心的患者在 30 天死亡率（5.5% vs. 5.6%；P=0.94）、卒中（1.1% vs. 1.3%；P=0.66）或大出血（1.5% vs. 1.8%；P=0.65）或再梗死/缺血（1.2% vs. 2.5%；P=0.088）方面无显著差异，尽管门球时间明显延长。
在区域 STEMI 护理系统中，对于由于长途转院而预计会延迟的 STEMI 患者，半剂量溶栓联合即刻转院行直接 PCI 可能是一种安全有效的选择。
