Kobayashi Akihiro, Misumida Naoki, Aoi Shunsuke, Steinberg Eric, Kearney Kathleen, Fox John T, Kanei Yumiko
Department of Internal Medicine, Mount Sinai Beth Israel, New York.
Department of Internal Medicine, Mount Sinai Beth Israel, New York.
Am J Emerg Med. 2016 Aug;34(8):1610-3. doi: 10.1016/j.ajem.2016.06.022. Epub 2016 Jun 7.
Emergency medical services (EMS) transportation is associated with shorter door-to-balloon (DTB) time in patients with ST-segment elevation myocardial infarction (STEMI). In addition to EMS transportation, prehospital notification of STEMI by EMS to receiving hospital might be able to further shorten DTB time. We evaluated the impact of STEMI notification on DTB time as well as infarct size.
We performed a retrospective analysis of consecutive patients with anterior wall STEMI who underwent emergent coronary angiography. We excluded patients who presented with cardiac arrest and those who were transferred from non-percutaneous coronary intervention-capable hospitals. Mode of transportation were categorized into the 3 groups: (1) EMS transport with STEMI notification, (2) EMS transport without STEMI notification, and (3) self-transport. Baseline characteristics, laboratory data, left ventricular ejection fraction (LVEF), and DTB time were compared among the 3 groups.
A total of 148 patients were included in the final analysis. Of the 148 patients, 56 patients arrived by EMS transport with STEMI notification, 56 patients arrived by EMS transport without STEMI notification, and 36 patients arrived by self-transport. Patients who arrived by EMS transport with STEMI notification had the shortest DTB time among the 3 groups. Patients who arrived by EMS transport with STEMI notification had smaller infarct size, as indicated by lower peak creatine kinase value and higher LVEF, compared with those who arrived by EMS transport without STEMI notification.
Emergency medical services transport with STEMI notification was associated with shorter DTB time and smaller infarct size in patients with anterior wall STEMI.
在ST段抬高型心肌梗死（STEMI）患者中，紧急医疗服务（EMS）转运与更短的门球时间（DTB）相关。除了EMS转运外，EMS在院前将STEMI情况通知接收医院可能能够进一步缩短DTB时间。我们评估了STEMI通知对DTB时间以及梗死面积的影响。
我们对连续接受急诊冠状动脉造影的前壁STEMI患者进行了回顾性分析。我们排除了心脏骤停患者以及从无经皮冠状动脉介入能力医院转诊的患者。交通方式分为3组：（1）有STEMI通知的EMS转运，（2）无STEMI通知的EMS转运，（3）自行转运。比较3组患者的基线特征、实验室数据、左心室射血分数（LVEF）和DTB时间。
最终分析共纳入148例患者。在这148例患者中，56例通过有STEMI通知的EMS转运到达，56例通过无STEMI通知的EMS转运到达，36例通过自行转运到达。在3组中，通过有STEMI通知的EMS转运到达的患者DTB时间最短。与无STEMI通知的EMS转运到达的患者相比，有STEMI通知的EMS转运到达的患者梗死面积更小，表现为肌酸激酶峰值更低和LVEF更高。
对于前壁STEMI患者，有STEMI通知的紧急医疗服务转运与更短的DTB时间和更小的梗死面积相关。
