Hagiwara Magnus Andersson, Bremer Anders, Claesson Andreas, Axelsson Christer, Norberg Gabriella, Herlitz Johan
School of Health Sciences, The Centre for Pre-hospital Research, University of Borås, SE-501 90, Borås, Sweden.
Inst of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, SE-413 45, Göteborg, Sweden.
Scand J Trauma Resusc Emerg Med. 2014 Nov 25;22:67. doi: 10.1186/s13049-014-0067-x.
For each hour of delay from fist medical contact until reperfusion in ST-elevation myocardial infarction (STEMI) there is a 10% increase in risk of death and heart failure. The aim of this review is to describe the impact of the direct admission of patients with STEMI to a Catheterisation laboratory (cath lab) as compared with transport to the emergency department (ED) with regard to delays and outcome.
Databases were searched for from April-June 2012 and updated January 2014: 1) Pubmed; 2) Embase; 3) Cochrane Library; 4) ProQuest Nursing and 5) Allied Health Sources. The search was restricted to studies in English, Swedish, Danish and Norwegian languages. The intervention was a protocol-based clinical pre-hospital pathway and main outcome measurements were the delay to balloon inflation and hospital mortality.
Median delay from door to balloon was significantly shorter in the intervention group in all 5 studies reported. Difference in median delay varied between 16 minutes and 47 minutes. In all 7 included studies the time from symptom onset or first medical contact to balloon time was significantly shorter in the intervention group. The difference in median delay varied between 15 minutes and 1 hour and 35 minutes. Only two studies described hospital mortality. When combined the risk of death was reduced by 37%.
An overview of available studies of the impact of a protocol-based pre-hospital clinical pathway with direct admission to a cath lab as compared with the standard transport to the ED in ST-elevation AMI suggests the following. The delay to the start of revascularisation will be reduced. The clinical benefit is not clearly evidence based. However, the documented association between system delay and outcome defends the use of the pathway.
在ST段抬高型心肌梗死（STEMI）中，从首次医疗接触到再灌注每延迟一小时，死亡和心力衰竭风险就会增加10%。本综述的目的是描述STEMI患者直接进入导管室（心导管室）与转运至急诊科（ED）相比，在延迟和结局方面的影响。
检索2012年4月至6月的数据库，并于2014年1月更新：1）PubMed；2）Embase；3）Cochrane图书馆；4）ProQuest护理数据库和5）联合健康资源数据库。检索仅限于英文、瑞典文、丹麦文和挪威文的研究。干预措施是基于方案的临床院前路径，主要结局指标是球囊扩张延迟时间和医院死亡率。
在所有5项报告的研究中，干预组从入院到球囊扩张的中位延迟时间显著缩短。中位延迟时间的差异在16分钟至47分钟之间。在所有7项纳入研究中，干预组从症状发作或首次医疗接触到球囊扩张的时间显著缩短。中位延迟时间的差异在15分钟至1小时35分钟之间。只有两项研究描述了医院死亡率。合并后死亡风险降低了37%。
与ST段抬高型急性心肌梗死患者标准转运至急诊科相比，对基于方案的直接进入心导管室的院前临床路径影响的现有研究综述表明如下情况。血管重建开始的延迟将减少。临床获益尚无明确的循证依据。然而，系统延迟与结局之间已记录的关联支持该路径的使用。
