Martin Lorelle, Murphy Maria, Scanlon Andrew, Clark David, Farouque Omar
LaTrobe University School of Nursing, Melbourne, Australia Department of Cardiology, Austin Health, Heidelberg, Australia
LaTrobe University School of Nursing, Melbourne, Australia Department of Cardiology, Austin Health, Heidelberg, Australia.
Eur J Cardiovasc Nurs. 2016 Apr;15(3):e37-44. doi: 10.1177/1474515115577294. Epub 2015 Mar 17.
Guidelines for the management of ST-segment elevation myocardial infarction (STEMI) recommend a 'door to balloon time' (DTBT) within 90 minutes. It is unclear whether strategies to reduce DTBT translate to improved longer-term health outcomes for STEMI patients.
This study sought to determine whether implemented strategies to improve timely management of STEMI reduced DTBT and impacted upon health outcomes such as length of stay, unplanned readmission and 12-month mortality. Predictors of timely management for STEMI were also examined.
A five-year review was undertaken on primary percutaneous coronary intervention for STEMI in one tertiary hospital. Comparisons were made between process change groups and DTBT. Logistic regression identified predictors of timely management.
470 STEMI patients underwent immediate primary percutaneous coronary intervention. Process change improved the median DTBT (109 min vs. 72 min, p<0.001) with no significant effect on length of stay (p=0.83), unplanned cardiac readmissions (p=0.68) or 12-month mortality (9.0% vs. 8.6%, p=0.64). Those receiving timely treatment (i.e. DTBT< 90 min) were younger (p<0.05), male (p<0.03), presented via ambulance (p<0.004), during business hours (p<0.0001) and had a lower Thrombolysis In Myocardial Infarction score (p<0.006). Timely treatment was associated with lower 12-month mortality (3.7% vs. 15.7%, p<0.0001) and increased uptake of inpatient cardiac rehabilitation (p<0.005), with length of stay and unplanned readmission similar between groups (p=NS).
Process changes improved DTBT but had no effect on length of stay, readmission rate or 12-month mortality. Yet, timely management was critical to 12-month outcomes. Further studies are required to explore the barriers to timely treatment.
ST段抬高型心肌梗死（STEMI）管理指南推荐“门球时间”（DTBT）在90分钟内。目前尚不清楚缩短DTBT的策略是否能转化为改善STEMI患者的长期健康结局。
本研究旨在确定实施的改善STEMI及时管理的策略是否能缩短DTBT，并对住院时间、非计划再入院和12个月死亡率等健康结局产生影响。还研究了STEMI及时管理的预测因素。
对一家三级医院的STEMI直接经皮冠状动脉介入治疗进行了为期五年的回顾。对流程变更组和DTBT进行了比较。逻辑回归确定了及时管理的预测因素。
470例STEMI患者接受了直接经皮冠状动脉介入治疗。流程变更改善了中位DTBT（109分钟对72分钟，p<0.001），但对住院时间（p=0.83）、非计划心脏再入院（p=0.68）或12个月死亡率（9.0%对8.6%，p=0.64）无显著影响。接受及时治疗（即DTBT<90分钟）的患者更年轻（p<0.05）、男性（p<0.03）、通过救护车就诊（p<0.004）、在工作时间（p<0.0001）且心肌梗死溶栓评分较低（p<0.006）。及时治疗与较低的12个月死亡率（3.7%对15.7%，p<0.0001）和住院心脏康复利用率增加（p<0.005）相关，两组间住院时间和非计划再入院相似（p=无显著性差异）。
流程变更改善了DTBT，但对住院时间、再入院率或12个月死亡率无影响。然而，及时管理对12个月结局至关重要。需要进一步研究以探索及时治疗的障碍。
