Nakamura Masato, Yamagishi Masakazu, Ueno Takafumi, Hara Kazuhiro, Ishiwata Sugao, Itoh Tomonori, Hamanaka Ichiro, Wakatsuki Tetsuzo, Sugano Teruyasu, Kawai Kazuya, Kimura Takeshi
Department of Cardiovascular Medicine, Ohashi Medical Center, Toho University, Tokyo, Japan.
Cardiovasc Interv Ther. 2013 Jan;28(1):30-6. doi: 10.1007/s12928-012-0128-x. Epub 2012 Sep 16.
The door-to-balloon time and total ischemic time are important predictors of the outcome in patients with ST elevation myocardial infarction (STEMI) receiving primary angioplasty, but the current situation in Japan is unknown. The Japan Acute Myocardial Infarction registry is a prospective observational study of 2,030 consecutive STEMI patients admitted to 213 Japanese institutions. The time from symptom onset to hospital arrival, door-to-balloon time, and in-hospital outcome were assessed. Data were compared between patients treated during regular hours or after hours. Percutaneous coronary angioplasty was done in 97.2 % of the patients, using drug-eluting stents in 30 % and bare metal stents in 63 % of the treated cases. The median symptom onset-to-door time (25th and 75th percentiles) was 135 min (64-305 min), median door-to-balloon time was 42 min (28-66 min), and mean procedural time was 98 ± 51 min. The on-call catheterization team performed 48.5 % of the procedures. There was no significant difference of door-to-balloon time between the patients treated after hours and those treated during regular hours. The cardiac mortality rate was 3.2 %, and it increased with longer door-to-balloon times (P = 0.03). The relationship between total ischemic time and cardiac mortality showed 2 peaks, with a trough at 5 h. Median door-to-balloon time was <90 min and was not longer in after hours cases. These findings suggest that Japanese institutions can provide primary angioplasty within an acceptable time frame.
对于接受直接血管成形术的ST段抬高型心肌梗死（STEMI）患者，门球时间和总缺血时间是预后的重要预测指标，但日本的现状尚不清楚。日本急性心肌梗死登记研究是一项对213家日本机构连续收治的2030例STEMI患者进行的前瞻性观察性研究。评估了从症状发作到入院的时间、门球时间和院内结局。比较了正常工作时间或非工作时间接受治疗的患者的数据。97.2%的患者接受了经皮冠状动脉成形术，其中30%使用药物洗脱支架，63%使用裸金属支架。症状发作至入院的中位时间（第25和第75百分位数）为135分钟（64 - 305分钟），门球中位时间为42分钟（28 - 66分钟），平均手术时间为98±51分钟。待命的导管插入术团队进行了48.5%的手术。非工作时间接受治疗的患者与正常工作时间接受治疗的患者的门球时间无显著差异。心脏死亡率为3.2%，且随着门球时间延长而增加（P = 0.03）。总缺血时间与心脏死亡率之间的关系呈现两个峰值，在5小时处有一个低谷。门球中位时间<90分钟，非工作时间病例的门球时间也没有更长。这些发现表明，日本机构能够在可接受的时间范围内提供直接血管成形术。
