Fujii Toshiharu, Masuda Naoki, Suzuki Toshihiko, Trii Sho, Murakami Tsutomu, Nakano Masataka, Nakazawa Gaku, Shinozaki Norihiko, Matsukage Takashi, Ogata Nobuhiko, Yoshimachi Fuminobu, Ikari Yuji
Division of Cardiology, Tokai University School of Medicine, Isehara, Japan.
Division of Cardiology, Tokai University School of Medicine, Isehara, Japan.
J Cardiol. 2014 Jul;64(1):11-8. doi: 10.1016/j.jjcc.2013.11.008. Epub 2014 Jan 4.
Reducing total ischemic time is important in achieving better outcome in ST-segment elevation myocardial infarction (STEMI). Although the onset-to-door (OTD) time accounts for a large portion of the total ischemic time, factors affecting prolongation of the OTD time are not established.
The purpose of this study was to determine the impact of transport pathways on OTD time in patients with STEMI.
We retrospectively studied 416 STEMI patients who were divided into 4 groups according to their transport pathways; Group 1 (n = 41): self-transportation to percutaneous coronary intervention (PCI) facility; Group 2 (n = 215): emergency medical service (EMS) transportation to PCI facility; Group 3 (n = 103): self-transportation to non-PCI facility; and Group 4 (n = 57): EMS transportation to non-PCI facility. OTD time was compared among the 4 groups.
Median OTD time for all groups combined was 113 (63-228.8)min [Group 1, 145 (70-256.5); Group 2, 71 (49-108); Group 3, 260 (142-433); and Group 4, 184 (130-256)min]. OTD time for EMS users (Groups 2 and 4) was 138 min shorter than non-EMS users (Groups 1 and 3). Inter-hospital transportation (Groups 3 and 4) prolonged OTD by a median of 132 min compared with direct transportation to PCI facility (Groups 1 and 2). Older age, history of myocardial infarction, prior PCI, shock at onset, high Killip classification, and high GRACE Risk Score were significantly more frequent in EMS users.
Self-transportation without EMS and inter-hospital transportation were significant factors causing prolongation of the OTD time. Approximately 35% of STEMI patients did not use EMS and 21% of patients were transported to non-PCI facilities even though they called EMS. Awareness in the community as well as among medical professionals to reduce total ischemic time of STEMI is necessary; this involves educating the general public and EMS crews.
在ST段抬高型心肌梗死（STEMI）中，减少总缺血时间对于获得更好的治疗结果至关重要。尽管从发病到入院（OTD）时间占总缺血时间的很大一部分，但影响OTD时间延长的因素尚未明确。
本研究的目的是确定转运途径对STEMI患者OTD时间的影响。
我们回顾性研究了416例STEMI患者，根据其转运途径将他们分为4组；第1组（n = 41）：自行转运至经皮冠状动脉介入治疗（PCI）机构；第2组（n = 215）：通过紧急医疗服务（EMS）转运至PCI机构；第3组（n = 103）：自行转运至非PCI机构；第4组（n = 57）：通过EMS转运至非PCI机构。比较4组之间的OTD时间。
所有组的OTD时间中位数为113（63 - 228.8）分钟[第1组，145（70 - 256.5）；第2组，71（49 - 108）；第3组，260（142 - 433）；第4组，184（130 - 256）分钟]。使用EMS的患者（第2组和第4组）的OTD时间比未使用EMS的患者（第1组和第3组）短138分钟。与直接转运至PCI机构（第1组和第2组）相比，院间转运（第3组和第4组）使OTD时间中位数延长了132分钟。使用EMS的患者中，年龄较大、有心肌梗死病史、既往PCI史、发病时休克、Killip分级高和GRACE风险评分高的情况明显更常见。
不使用EMS的自行转运和院间转运是导致OTD时间延长的重要因素。约35%的STEMI患者未使用EMS，即使呼叫了EMS，仍有21%的患者被转运至非PCI机构。社区以及医疗专业人员提高对减少STEMI总缺血时间的认识很有必要；这包括对普通公众和EMS工作人员进行教育。
