Sullivan Alison L, Beshansky Joni R, Ruthazer Robin, Murman David H, Mader Timothy J, Selker Harry P
Baystate Medical Center, and Center for Cardiovascular Health Services Research, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA; and Tufts University School of Medicine, and Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA.
Circ Cardiovasc Qual Outcomes. 2014 Jan;7(1):86-94. doi: 10.1161/CIRCOUTCOMES.113.000396. Epub 2014 Jan 14.
Rapid treatment of acute coronary syndromes (ACS) is important; causes of delay in emergency medical services care of ACS are poorly understood.
We performed an analysis of data from IMMEDIATE (Immediate Myocardial Metabolic Enhancement during Initial Assessment and Treatment in Emergency Care), a randomized controlled trial of emergency medical services treatment of people with symptoms suggesting ACS, using hierarchical multiple regression of elapsed time. Out-of-hospital ECGs were performed on 54,230 adults calling 9-1-1; 871 had presumed ACS, 303 of whom had ST-segment elevation myocardial infarction and underwent percutaneous coronary intervention. Women, participants with diabetes mellitus, and participants without previous cardiovascular disease waited longer to call 9-1-1 (by 28 minutes, P<0.01; 10 minutes, P=0.03; and 6 minutes, P=0.02, respectively), compared with their counterparts. Time from emergency medical services arrival to ECG was longer for women (1.5 minutes; P<0.01), older individuals (1.3 minutes; P<0.01), and those without a primary complaint of chest pain (3.5 minutes; P<0.01). On-scene times were longer for women (2 minutes; P<0.01) and older individuals (2 minutes; P<0.01). Older individuals and participants presenting on weekends and nights had longer door-to-balloon times (by 10, 14, and 11 minutes, respectively; P<0.01). Women and older individuals had longer total times (medical contact to balloon inflation: 16 minutes, P=0.01, and 9 minutes, P<0.01, respectively; symptom onset to balloon inflation: 31.5 minutes for women; P=0.02).
We found delays throughout ACS care, resulting in substantial differences in total times for women and older individuals. These delays may impact outcomes; a comprehensive approach to reduce delay is needed.
急性冠状动脉综合征（ACS）的快速治疗至关重要；但对于紧急医疗服务中ACS治疗延迟的原因，人们了解甚少。
我们对IMMEDIATE（紧急护理初始评估和治疗期间即时心肌代谢增强）试验的数据进行了分析，该试验是一项针对有ACS症状患者的紧急医疗服务治疗的随机对照试验，采用了时间流逝的分层多元回归分析。对拨打911的54230名成年人进行了院外心电图检查；其中871人疑似患有ACS，303人患有ST段抬高型心肌梗死并接受了经皮冠状动脉介入治疗。与男性相比，女性、患有糖尿病的参与者以及既往无心血管疾病的参与者拨打911的时间更长（分别长28分钟，P<0.01；10分钟，P=0.03；6分钟，P=0.02）。女性（1.5分钟；P<0.01）、老年人（1.3分钟；P<0.01）以及无胸痛主诉的患者（3.5分钟；P<0.01）从紧急医疗服务到达至进行心电图检查的时间更长。女性（2分钟；P<0.01）和老年人（2分钟；P<0.01）的现场停留时间更长。在周末和夜间就诊的老年人和参与者的门球时间更长（分别长10、14和11分钟；P<0.01）。女性和老年人的总时间更长（从医疗接触到球囊扩张：分别为16分钟，P=0.01；9分钟，P<0.01；从症状发作到球囊扩张：女性为31.5分钟；P=0.02）。
我们发现整个ACS治疗过程中均存在延迟，导致女性和老年人的总时间存在显著差异。这些延迟可能会影响治疗结果；需要采取综合方法来减少延迟。
