University Hospital Antwerp, Edegem, Belgium.
Eur Heart J Acute Cardiovasc Care. 2012 Apr;1(1):40-7. doi: 10.1177/2048872612441579.
Reports examining local ST elevation myocardial infarction (STEMI) networks focused mainly on percutaneous coronary intervention (PCI)-related time issues and outcomes. To validate the concept of STEMI networks in a real-world context, more data are needed on management and outcome of an unselected community based STEMI population.
The current study evaluated reperfusion strategies and in-hospital mortality in 8500 unselected STEMI patients admitted to 47 community hospitals (n=3053) and 25 PCI-capable hospitals (n=5447) in the context of a nationwide STEMI network programme that started in 2007 in Belgium. The distance between the hub and spoke hospitals ranged from 2.2 to 47 km (median 15 km). A propensity score was used to adjust for differences in baseline characteristics. Reperfusion strategy was significantly different with a predominant use of primary PCI (pPCI) in PCI-capable hospitals (93%), compared to a mixed use of pPCI (71%) and thrombolysis (20%) in community hospitals. A door-to-balloon time <120 min was achieved in 83% of community hospitals and in 91% of PCI-capable hospitals (p<0.0001). In-hospital mortality was 7.0% in community hospitals versus 6.7% in PCI-capable hospitals with an adjusted odds ratio of 1.1 (95% confidence interval: 0.8-1.4). Between the periods 2007-2008 and 2009-2010, the pPCI rate in community hospitals increased from 60% to 80%, whereas the proportion of conservatively managed patients decreased from 11.1% to 7.9%.
In a STEMI network with >70% use of pPCI, in-hospital mortality was comparable between community hospitals and PCI-capable hospitals. Participation in the STEMI network programme was associated with an increased adherence to reperfusion guidelines over time.
研究局部 ST 段抬高型心肌梗死 (STEMI) 网络的报告主要集中在经皮冠状动脉介入治疗 (PCI) 相关的时间问题和结果上。为了在真实环境中验证 STEMI 网络的概念，需要更多关于基于社区的未选择 STEMI 人群的管理和结果的数据。
本研究评估了 2007 年在比利时启动的全国性 STEMI 网络项目中，8500 例未经选择的 STEMI 患者在 47 家社区医院（n=3053）和 25 家有 PCI 能力的医院（n=5447）中的再灌注策略和住院死亡率。枢纽和分支机构医院之间的距离为 2.2 至 47 公里（中位数为 15 公里）。使用倾向评分来调整基线特征的差异。再灌注策略明显不同，有 PCI 能力的医院主要采用直接经皮冠状动脉介入治疗（pPCI）（93%），而社区医院则混合采用 pPCI（71%）和溶栓治疗（20%）。83%的社区医院和 91%的有 PCI 能力的医院实现了门球时间<120 分钟（p<0.0001）。社区医院的住院死亡率为 7.0%，有 PCI 能力的医院为 6.7%，调整后的优势比为 1.1（95%置信区间：0.8-1.4）。在 2007-2008 年和 2009-2010 年期间，社区医院的 pPCI 率从 60%增加到 80%，而保守治疗患者的比例从 11.1%下降到 7.9%。
在一个>70%采用 pPCI 的 STEMI 网络中，社区医院和有 PCI 能力的医院之间的住院死亡率相当。随着时间的推移，参与 STEMI 网络项目与再灌注指南的遵守率增加有关。
