Loh Joshua P, Satler Lowell F, Pendyala Lakshmana K, Minha Sa'ar, Frohna William J, Torguson Rebecca, Chen Fang, Suddath William O, Pichard Augusto D, Waksman Ron
Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
Department of Emergency Medicine, MedStar Washington Hospital Center, Washington, DC.
Cardiovasc Revasc Med. 2014 Jun;15(4):219-25. doi: 10.1016/j.carrev.2014.03.011. Epub 2014 Mar 26.
To determine whether door-to-balloon (DTB) times of patients presenting with ST-elevation myocardial infarction (STEMI) were reduced in patients transported by emergency medical services (EMS) compared to those who were self-transported. DTB time is an important measure of hospital care processes in STEMI. Use of EMS may expedite in-hospital processing and reduce DTB times. A total of 309 consecutive STEMI patients who underwent primary percutaneous coronary intervention in our institution were analyzed. Excluded were patients who received fibrinolytics, presented in cardiac arrest, were intubated, or were transferred from another hospital. EMS-transported patients (n=83) were compared to self-transported patients (n=226). The primary outcome measure was DTB time and its component time intervals. Secondary end points included symptom-to-door and symptom-to-balloon times, and correlates for DTB >90 minutes. A higher percentage of EMS-transported patients reached the time goal of DTB <90 minutes compared to self-transported patients (83.1 versus 54.3%; p<0.001). EMS-transported patients had shorter DTB times [median (IQR) minutes, 65 (50-86) versus 85 (61-126); p<0.001] due to a reduction of emergency department processing (door-to-call) time, whereas catheterization laboratory processing (call-to-balloon) times were similar in both groups. EMS-transported patients had shorter symptom-to-door [median (IQR) hours, 1.2 (0.8-3.5) versus 2.3 (1.2-7.5); p<0.001] and symptom-to-balloon [median (IQR) hours, 2.5 (1.9-4.7) versus 4.3 (2.6-9.1); p<0.001]. Independent correlates of DTB times >90 minutes were self-transport (odds ratio 5.32, 95% CI 2.65-10.70; p<0.001) and off-hours presentation (odds ratio 2.89, 95% CI 1.60-5.22; p<0.001). Use of EMS transport in STEMI patients significantly shortens time to reperfusion, primarily by expediting emergency department processes. Community education efforts should focus not only on the importance of recognizing symptoms of myocardial infarction, but also taking early action by calling the EMS.
为了确定与自行转运的患者相比，由紧急医疗服务（EMS）转运的ST段抬高型心肌梗死（STEMI）患者的门球时间（DTB）是否缩短。DTB时间是STEMI医院护理流程的一项重要指标。使用EMS可能会加快院内处理流程并缩短DTB时间。对我院连续309例接受直接经皮冠状动脉介入治疗的STEMI患者进行了分析。排除了接受纤溶治疗、心脏骤停就诊、插管或从其他医院转诊的患者。将EMS转运的患者（n = 83）与自行转运的患者（n = 226）进行比较。主要结局指标是DTB时间及其组成时间间隔。次要终点包括症状到入院时间和症状到球囊时间，以及DTB>90分钟的相关因素。与自行转运的患者相比，EMS转运的患者达到DTB<90分钟时间目标的比例更高（83.1%对54.3%；p<0.001）。由于急诊科处理（门到呼叫）时间缩短，EMS转运的患者DTB时间较短[中位数（IQR）分钟，65（50 - 86）对85（61 - 126）；p<0.001]，而两组的导管室处理（呼叫到球囊）时间相似。EMS转运的患者症状到入院时间[中位数（IQR）小时，1.2（0.8 - 3.5）对2.3（1.2 - 7.5）；p<0.001]和症状到球囊时间[中位数（IQR）小时，2.5（1.9 - 4.7）对4.3（2.6 - 9.1）；p<0.001]较短。DTB时间>90分钟的独立相关因素是自行转运（比值比5.32，95%CI 2.65 - 10.70；p<0.001）和非工作时间就诊（比值比2.89，95%CI 1.60 - 5.22；p<0.001）。在STEMI患者中使用EMS转运可显著缩短再灌注时间，主要是通过加快急诊科流程。社区教育工作不仅应关注识别心肌梗死症状的重要性，还应强调通过呼叫EMS尽早采取行动。
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