Division of Cardiology, University of North Carolina, Chapel Hill, NC 27599-7075, USA.
Nat Rev Cardiol. 2016 Mar;13(3):148-54. doi: 10.1038/nrcardio.2015.165. Epub 2015 Nov 3.
ST-segment elevation myocardial infarction (STEMI) is most commonly caused by an acute thrombotic occlusion of a coronary artery. For patients in whom the onset of STEMI occurs outside of hospital (outpatient STEMI), early reperfusion therapy with either fibrinolysis or primary percutaneous coronary intervention reduces complications and improves survival, compared with delayed reperfusion. STEMI systems of care are defined as integrated groups of separate entities focused on reperfusion therapy for STEMI, generally including emergency medical services, emergency medicine, cardiology, nursing, and hospital administration. These systems of care have been successful at reducing total ischaemia time and outpatient STEMI mortality. By contrast, much less is known about STEMI that occurs in hospitalized patients (inpatient STEMI), which has unique clinical features and much worse outcomes than outpatient STEMI. Inpatient STEMI is associated with older age, a higher female:male ratio, and more comorbidities than outpatient STEMI. Delays in diagnosis and infrequent use of reperfusion therapy probably also contribute to unfavourable outcomes for inpatient STEMI.
ST 段抬高型心肌梗死（STEMI）最常由冠状动脉的急性血栓闭塞引起。对于在院外（门诊 STEMI）发生 STEMI 的患者，与延迟再灌注相比，早期溶栓或直接经皮冠状动脉介入治疗可减少并发症并提高生存率。STEMI 护理系统被定义为专注于 STEMI 再灌注治疗的独立实体的综合群组，通常包括紧急医疗服务、急诊医学、心脏病学、护理和医院管理。这些护理系统在缩短总缺血时间和降低门诊 STEMI 死亡率方面取得了成功。相比之下，人们对住院患者（住院 STEMI）发生的 STEMI 知之甚少，住院 STEMI 具有独特的临床特征，其结局比门诊 STEMI 更差。与门诊 STEMI 相比，住院 STEMI 患者年龄更大、女性：男性比例更高、合并症更多。诊断延迟和再灌注治疗的应用不频繁也可能导致住院 STEMI 的不良结局。
