Mol K A, Rahel B M, Meeder J G, van Casteren B C A M, Doevendans P A, Cramer M J M
Department of Cardiology, VieCuri Medisch Centrum Venlo, Tegelseweg 210, 5912BL Venlo, the Netherlands.
Medisch Centrum Veltum, Langstraat 100, 5801AG, Venray, the Netherlands.
Int J Cardiol. 2016 Oct 15;221:1061-6. doi: 10.1016/j.ijcard.2016.07.082. Epub 2016 Jul 16.
Delays in patients suspected of acute coronary syndrome (ACS) should be kept as short as possible to reduce complications and mortality. In this review we discuss the substantial pre-hospital delays of ST-elevated myocardial infarction (STEMI) patients as well as non-STEMI patients. The pre-hospital delays include patient, doctor and emergency medical transport (EMT) delay. Patient delay is among the longest in the pre-hospital chain of ACS patients. Interventions as mass media campaigns or individual education programs have not yet shown much improvement. Patients with chest pain most often contact the general practitioner (GP) instead of the recommended EMT, increasing delays as well. To decrease the delays by referring all patients promptly and without restriction to the emergency department (ED) is not feasible. Up to 80% of the patients with chest pain do not have a cardiac diagnosis and thus referral of all these patients would result in overcrowding of the ED. Triage is therefore crucial. Triage of patients with chest pain is therefore imperative and there is a great need of (validated) triage tools.
对于疑似急性冠状动脉综合征（ACS）的患者，应尽可能缩短延误时间，以减少并发症和死亡率。在本综述中，我们讨论了ST段抬高型心肌梗死（STEMI）患者以及非STEMI患者在院前的大量延误情况。院前延误包括患者延误、医生延误和紧急医疗转运（EMT）延误。患者延误是ACS患者院前环节中最长的部分之一。诸如大众媒体宣传活动或个体教育项目等干预措施尚未显示出太大改善。胸痛患者最常联系全科医生（GP）而非推荐的紧急医疗服务，这也增加了延误。通过不加限制地立即将所有患者转诊至急诊科（ED）来减少延误并不可行。高达80%的胸痛患者没有心脏诊断，因此将所有这些患者转诊会导致急诊科过度拥挤。因此，分诊至关重要。因此，对胸痛患者进行分诊势在必行，而且非常需要（经过验证的）分诊工具。
