2nd Department of Medicine, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstr. 1, 55131, Mainz, Germany.
Clin Res Cardiol. 2012 Dec;101(12):983-91. doi: 10.1007/s00392-012-0487-4. Epub 2012 Jul 25.
In an attempt to improve the treatment of patients with acute coronary syndromes (ACS), a network of certified chest pain units (CPUs) has been recently established in Germany.
Data from patients admitted between December 2008 and September 2011 for ACS in 40 certified CPUs participating in the registry were prospectively collected.
A total of 5,457 patients was admitted for ACS; 798 patients (14.6 %) were diagnosed with an ST-elevation myocardial infarction (STEMI), 2,244 (41.1 %) with a non-ST-elevation myocardial infarction (NSTEMI), and 2,415 (44.3 %) with unstable angina. The mean time to first medical contact was 2:08 h for STEMI patients. A pre-hospital ECG was available in 23.8 % of all ACS patients. Importantly, evidence of ST-segment elevation was present in 79.7 % of the STEMI patients already in this pre-hospital ECG. As many as 76.6 % of the patients, independently of their symptoms and final diagnosis, received an ECG within 10 min of reaching the CPU. 98.2 % of STEMI patients underwent invasive diagnostics, with an in-hospital delay as little as 31 (11-75) min.
The establishment of a nation-wide network of certified CPUs optimizes the medical treatment of patients with ACS while providing an ideal infrastructure to evaluate and improve, both on a nation-wide and a single center scale, the adherence to guidelines. The median delay between symptom onset and first medical contact remains high. Although performed relatively rarely, a pre-hospital ECG facilitates earlier diagnosis of a STEMI in a large majority of patients. The introduction of CPUs minimizes in-hospital delays and exploits the benefit of invasive diagnostics and treatment.
为改善急性冠状动脉综合征（ACS）患者的治疗效果，德国最近建立了一个经过认证的胸痛单元（CPU）网络。
前瞻性收集了参与该注册研究的 40 个经认证的 CPU 中，2008 年 12 月至 2011 年 9 月期间因 ACS 入院的患者的数据。
共收治 5457 例 ACS 患者；798 例（14.6%）诊断为 ST 段抬高型心肌梗死（STEMI），2244 例（41.1%）为非 ST 段抬高型心肌梗死（NSTEMI），2415 例（44.3%）为不稳定型心绞痛。STEMI 患者首次医疗接触的平均时间为 2 小时 8 分。所有 ACS 患者中，有 23.8%的患者可获得院前心电图。重要的是，在这个院前心电图中，已经有 79.7%的 STEMI 患者存在 ST 段抬高的证据。多达 76.6%的患者，无论其症状和最终诊断如何，在到达 CPU 后 10 分钟内都接受了心电图检查。98.2%的 STEMI 患者接受了有创诊断，住院时间仅为 31（11-75）分钟。
建立全国性的认证 CPU 网络，优化了 ACS 患者的治疗效果，同时为在全国和单个中心层面评估和改进指南的依从性提供了理想的基础设施。从症状发作到首次医疗接触的中位数延迟仍然很高。虽然进行的相对较少，但院前心电图在大多数患者中有助于更早地诊断 STEMI。CPU 的引入最大限度地减少了住院时间延迟，并利用了有创诊断和治疗的优势。
