Zhang You, Gao Chuanyu, Duan Guangcai, Liu Xinyun, Zhang Hua, Zhang Caili, Hu Dayi
Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China.
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Zhonghua Xin Xue Guan Bing Za Zhi. 2015 Oct;43(10):858-62.
To observe the early reperfusion therapy status for patients with ST elevation acute myocardial infarction (STEMI) hospitalized in tertiary and secondary hospitals in Henan province.
Baseline data, early reperfusion treatment and in-hospital mortality of STEMI patients hospitalized in 17 hospitals in Henan province (8 tertiary hospitals, 9 secondary hospitals) from June 2011 to June 2012 were obtained using a uniformed questionnaire.
One thousand six hundred and eighty six patients were enrolled, of which 886 patients were hospitalized in tertiary hospitals and 880 patients were early hospitalized in secondary hospitals. Six hundred and fifty four patients (38.8%, 654/1 686) underwent early reperfusion therapy (543 with thrombolysis and 111 with primary percutaneous coronary intervention (PCI)). There was no difference in the proportion of early reperfusion therapy between tertiary and secondary hospitals (40.1% (355/886) vs. 37.4% (299/800), P = 0.257). The median time from symptom onset to first medical contact, door-to-needle and door-to-balloon was 132 min, 18 min and 60 min, respectively. The median time from symptom onset to first medical contact (150 min vs. 120 min, P = 0.001), door-to-needle (30 min vs. 18 min, P = 0.003) and symptom onset-to-thrombolysis (3.5 h vs. 2.7 h, P = 0.001) were significantly longer in tertiary hospitals than in secondary hospitals. No difference was found in median time of door-to-balloon, symptom onset-to-primary PCI or symptom onset-to-elected PCI between tertiary and secondary hospitals (all P > 0.05). The proportion of door-to-needle ≤ 30 min was lower in tertiary hospitals than in secondary hospitals (46.4% (84/181) vs. 62.2% (153/246), P = 0.001). However, there was no difference in the proportion of door-to-balloon ≤ 90 min between tertiary and secondary hospitals (58.8% (60/102) vs. 57.1% (4/7), P = 1.000). In-hospital mortality was also similar between tertiary and secondary hospitals (5.8% (51/886) vs. 5.5% (44/800), P = 0.820).
Early reperfusion rate is low, and thrombolysis is the main early reperfusion therapy in both tertiary and secondary hospitals in Henan province. Tertiary hospitals did not take advantage of their primary PCI capability. There is great room for improvement in early reperfusion therapy in tertiary and secondary hospitals.
观察河南省三级和二级医院收治的ST段抬高型急性心肌梗死（STEMI）患者的早期再灌注治疗情况。
采用统一问卷收集2011年6月至2012年6月在河南省17家医院（8家三级医院、9家二级医院）住院的STEMI患者的基线资料、早期再灌注治疗情况及院内死亡率。
共纳入1686例患者，其中886例在三级医院住院，880例早期在二级医院住院。654例患者（38.8%，654/1686）接受了早期再灌注治疗（543例溶栓治疗，111例直接经皮冠状动脉介入治疗（PCI））。三级医院和二级医院早期再灌注治疗比例无差异（40.1%（355/886）对37.4%（299/800），P = 0.257）。症状发作至首次医疗接触、门至针和门至球囊的中位时间分别为132分钟、18分钟和60分钟。三级医院症状发作至首次医疗接触的中位时间（分别为150分钟对120分钟，P = 0.001）、门至针时间（分别为30分钟对18分钟，P = 0.003）和症状发作至溶栓时间（分别为3.5小时对2.7小时，P = 0.001）显著长于二级医院。三级医院和二级医院之间门至球囊、症状发作至直接PCI或症状发作至择期PCI的中位时间无差异（均P > 0.05）。三级医院门至针≤30分钟的比例低于二级医院（46.4%（84/181）对62.2%（153/246），P = 0.001）。然而，三级医院和二级医院之间门至球囊≤90分钟的比例无差异（58.8%（60/102）对57.1%（4/7），P = 1.000）。三级医院和二级医院的院内死亡率也相似（5.8%（51/886）对5.5%（44/800），P = 0.820）。
早期再灌注率较低，溶栓是河南省三级和二级医院早期再灌注治疗的主要方式。三级医院未充分发挥其直接PCI能力。三级和二级医院的早期再灌注治疗有很大的改进空间。
