Sigmundsson Thórir S, Arnarson Daníel, Rafnsson Arnar, Magnússon Viðar, Gunnarsson Gunnar Thór, Thorgeirsson Gestur
Laeknabladid. 2016 Jan;102(1):11-7. doi: 10.17992/lbl.2016.01.59.
ST-segment Elevation Myocardial Infarction (STEMI) is a life-threatening disease and good outcome depends on early restoration of coronary blood flow. Primary percutaneous coronary intervention (PPCI) is the treatment of choice if performed within 120 minutes of first medical contact (FMC) but in case of anticipated long transport or delays, pre-hospital fibrinolysis is indicated. The aim was to study transport times and adherence to clinical guidelines in patients with STEMI transported from outside of the Reykjavik area to Landspitali University Hospital in Iceland.
Retrospective chart review was conducted of all patients diagnosed with STEMI outside of the Reykjavik area and transported to Landspitali University Hospital in Reykjavik in 2011-2012. Descriptive statistical analysis and hypothesis testing was applied.
Eighty-six patients had signs of STEMI on electrocardiogram (ECG) at FMC. In southern Iceland nine patients (21%) underwent PPCI within 120 minutes (median 157 minutes) and no patient received fibrinolysis. In northern Iceland and The Vestman Islands, where long transport times are expected, 96% of patients eligible for fibrinolysis (n=31) received appropriate therapy in a median time of 57 minutes. Significantly fewer patients received appropriate anticoagulation treatment with clopidogrel and enoxaparin in southern Iceland compared to the northern part. Mortality rate was 7% and median length of stay in hospital was 6 days.
Time from FMC to PPCI is longer than 120 minutes in the majority of cases. Pre-hospital fibrinolysis should be considered as first line treatment in all parts of Iceland outside of the Reykjavik area. Directly electronically transmitted ECGs and contact with cardiologist could hasten diagnosis and decrease risk of unnecessary interhospital transfer. A STEMI database should be established in Iceland to facilitate quality control.
ST段抬高型心肌梗死（STEMI）是一种危及生命的疾病，良好的预后取决于冠状动脉血流的早期恢复。如果在首次医疗接触（FMC）后的120分钟内进行，直接经皮冠状动脉介入治疗（PPCI）是首选治疗方法，但如果预计转运时间较长或有延误，则应进行院前溶栓治疗。目的是研究从雷克雅未克地区以外转运至冰岛兰斯皮塔利大学医院的STEMI患者的转运时间及对临床指南的遵循情况。
对2011年至2012年期间在雷克雅未克地区以外被诊断为STEMI并转运至雷克雅未克的兰斯皮塔利大学医院的所有患者进行回顾性病历审查。应用描述性统计分析和假设检验。
86例患者在FMC时心电图（ECG）有STEMI迹象。在冰岛南部，9例患者（21%）在120分钟内（中位数157分钟）接受了PPCI，无患者接受溶栓治疗。在预计转运时间较长的冰岛北部和韦斯特曼群岛，96%符合溶栓条件的患者（n = 31）在中位数时间57分钟内接受了适当治疗。与北部相比，冰岛南部接受氯吡格雷和依诺肝素适当抗凝治疗的患者明显较少。死亡率为7%，住院中位时间为6天。
在大多数情况下，从FMC到PPCI的时间超过120分钟。在雷克雅未克地区以外的冰岛所有地区，院前溶栓应被视为一线治疗方法。直接电子传输心电图并与心脏病专家联系可加快诊断并降低不必要的院间转运风险。冰岛应建立STEMI数据库以促进质量控制。
