Karabulut Ahmet, Cakmak Mahmut, Uzunlar Bülent, Topçu Kadir
Clinic of Cardiology, İstanbul Medicine Hospital, İstanbul-Turkey.
Anadolu Kardiyol Derg. 2012 Feb;12(1):23-9. doi: 10.5152/akd.2012.005. Epub 2012 Jan 4.
The objective of this study was to evaluate the role of first contact emergency departments and ambulances on transport duration, pain-to-balloon time, door-to-balloon time and first contact-to-balloon time in acute myocardial infarction (AMI) patients.
The study was a prospective and observational investigation. A total of 374 AMI patients initially admitted to primary coronary intervention (PCI) incapable centers were included in this study. Patients were classified according to initial presentation site (daily clinic, public hospital or private hospital) and transport manner (public or private ambulance). All groups were compared by the Kruskal-Wallis and Mann-Whitney U tests statistically according to their characteristics, transport duration and pain-to-balloon time.
A majority of the patients were initially admitted to public (40.1%) or private hospitals (47.1%). The average door-to-balloon time was 45.0 ± 18.5 min and the mean pain-to-balloon time was 310.6 ± 160.8 min. Nearly half of the patients initially admitted to daily clinics were first transported to PCI-incapable centers, leading to delayed admission to PCI-capable centers and increased pain-to-balloon and first contact-to-balloon times (361.7 ± 194.5 min, p=0.01 and 279.7±158.2 min, p<0.001). Patients admitted to private hospitals experienced shorter average pain-to-balloon and first contact-to-balloon times (277.5 ± 148.6 min, p=0.01 and 157.4 ± 83.1 min, p<0.001). Patients transported by private ambulances also experienced shorter waiting times and shorter pain-to-balloon times (107.4 ± 70.4 and 270.1 ± 150.4 min, p<0.001).
Physicians and healthcare professionals in first contact emergency departments and ambulance type appear to be factors in the increased pain-to-balloon time. AMI patients are often initially admitted to PCI-incapable centers, leading to delayed admission to PCI-capable centers and increased pain-to-balloon time.
本研究旨在评估首次接诊急诊科及救护车在急性心肌梗死（AMI）患者转运时间、疼痛至球囊时间、门至球囊时间及首次接触至球囊时间方面所起的作用。
本研究为前瞻性观察性调查。共有374例最初收治于无直接经皮冠状动脉介入治疗（PCI）能力中心的AMI患者纳入本研究。患者根据初始就诊地点（日间诊所、公立医院或私立医院）及转运方式（公共或私人救护车）进行分类。根据各亚组的特征、转运时间及疼痛至球囊时间，采用Kruskal-Wallis检验和Mann-Whitney U检验进行统计学比较。
大多数患者最初收治于公立医院（40.1%）或私立医院（47.1%）。平均门至球囊时间为45.0±18.5分钟，平均疼痛至球囊时间为310.6±160.8分钟。近半数最初在日间诊所就诊的患者首先被转运至无PCI能力的中心，导致入住有PCI能力中心的时间延迟，疼痛至球囊时间及首次接触至球囊时间增加（分别为361.7±194.5分钟，p=0.01；279.7±158.2分钟，p<0.001）。收治于私立医院的患者平均疼痛至球囊时间及首次接触至球囊时间较短（分别为277.5±148.6分钟，p=0.01；157.4±83.1分钟，p<0.001）。乘坐私人救护车转运的患者等待时间及疼痛至球囊时间也较短（分别为107.4±70.4分钟和270.1±150.4分钟，p<0.001）。
首次接诊急诊科的医生及医护人员以及救护车类型似乎是导致疼痛至球囊时间增加的因素。AMI患者最初常收治于无PCI能力的中心，导致入住有PCI能力中心的时间延迟及疼痛至球囊时间增加。
