McCabe James M, Armstrong Ehrin J, Hoffmayer Kurt S, Bhave Prashant D, MacGregor John S, Hsue Priscilla, Stein John C, Kinlay Scott, Ganz Peter
Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, 75 Francis St., Boston, MA 02115, USA.
Circ Cardiovasc Qual Outcomes. 2012 Sep 1;5(5):672-9. doi: 10.1161/CIRCOUTCOMES.112.966382. Epub 2012 Sep 4.
Little is known about the components of door-to-balloon time among patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. We assessed the role of time from hospital arrival to ST-segment elevation myocardial infarction diagnosis (door-to-activation time) on door-to-balloon time in contemporary practice and evaluated factors that influence door-to-activation times.
Registry data on 347 consecutive patients diagnosed with a ST-segment elevation myocardial infarction in the emergency department over 30 months at 2 urban primary percutaneous coronary intervention centers were analyzed. The primary study end point was the time from hospital arrival to catheterization laboratory activation by the emergency department physician, and we assessed factors associated with this period. Door-to-balloon time and its other components were secondary study end points. The median door-to-activation time was 19 minutes (interquartile range, 9-54). Variation in door-to-activation times explained 93% of the variation in door-to-balloon times and demonstrated the strongest correlation with door-to-balloon times (r=0.97). Achieving a door-to-activation time of ≤20 minutes resulted in an 89% chance of achieving a door-to-balloon time of ≤90 minutes compared with only 28% for patients with a door-to-activation time >20 minutes. Factors significantly associated with door-to-activation time include the following: prehospital ECG use (61% shorter, 95% confidence interval, -50 to -72%; P<0.001) and computed tomography scan use in the emergency department (245% longer, 95% confidence interval, +50 to +399%; P=0.001).
The interval from hospital arrival to ST-segment elevation myocardial infarction diagnosis and catheterization laboratory activation (door-to-activation time) is a strong driver of overall door-to-balloon times. Achieving a door-to-activation time ≤20 minutes was key to achieving a door-to-balloon time ≤90 minutes. Delays in door-to-activation time are not associated with delays in other aspects of the primary percutaneous coronary intervention process.
对于接受直接经皮冠状动脉介入治疗的ST段抬高型心肌梗死患者，门球时间的构成因素了解甚少。我们评估了从入院到ST段抬高型心肌梗死诊断的时间（门到激活时间）在当代实践中对门球时间的作用，并评估了影响门到激活时间的因素。
分析了2个城市直接经皮冠状动脉介入治疗中心在30个月内急诊科连续诊断为ST段抬高型心肌梗死的347例患者的登记数据。主要研究终点是从入院到急诊科医生激活导管室的时间，我们评估了与此期间相关的因素。门球时间及其其他组成部分为次要研究终点。门到激活时间的中位数为19分钟（四分位间距，9 - 54分钟）。门到激活时间的变化解释了门球时间变化的93%，并显示与门球时间的相关性最强（r = 0.97）。与门到激活时间>20分钟的患者相比，门到激活时间≤20分钟的患者有89%的机会实现门球时间≤90分钟，而前者只有28%的机会。与门到激活时间显著相关的因素包括：院前心电图使用情况（缩短61%，95%置信区间，-50至-72%；P<0.001）和急诊科计算机断层扫描使用情况（延长245%，95%置信区间，+50至+399%；P = 0.001）。
从入院到ST段抬高型心肌梗死诊断及导管室激活的时间间隔（门到激活时间）是总体门球时间的重要驱动因素。实现门到激活时间≤20分钟是实现门球时间≤90分钟的关键。门到激活时间的延迟与直接经皮冠状动脉介入治疗过程其他方面的延迟无关。
