2004年至2012年纽约州ST段抬高型心肌梗死患者再灌注时间趋势分析。

Analysis of reperfusion time trends in patients with ST-elevation myocardial infarction across New York State from 2004 to 2012.

作者信息

Al'Aref Subhi J, Wong S Chiu, Swaminathan Rajesh V, McNair Patrick, Feldman Dmitriy N, Kim Luke K, Singh Harsimran S, Bergman Geoffrey, Minutello Robert M

机构信息

Division of Cardiology, Department of Medicine, NewYork Presbyterian Hospital - Weill Cornell Medical Center, New York, NY 10065, United States.

出版信息

Int J Cardiol. 2017 Apr 1;232:140-146. doi: 10.1016/j.ijcard.2017.01.039. Epub 2017 Jan 5.

DOI:10.1016/j.ijcard.2017.01.039

PMID:28082097

Abstract

BACKGROUND

Registry-driven data have shown a significant decrease in door-to-balloon (DTB) times in patients with ST-elevation myocardial infarction (STEMI) receiving percutaneous coronary intervention (PCI). We sought to determine the trends in reperfusion times (symptom-onset to door (SOTD) and DTB times) in patients presenting with STEMI across New York State.

METHODS

We retrospectively examined 35,613 STEMI patients receiving PCI from 2004 to 2012 and compared median SOTD and DTB times across years. Patients with SOTD time >12h and DTB time >3h were excluded.

RESULTS

There was a statistically significant trend towards shorter DTB times (median DTB time of 83min (IQR 53, 116) in 2004 to a median DTB time of 59min (IQR 40, 78) in 2012, P<0.01 for trend) and SOTD times (median SOTD time of 127min (IQR 64, 241) in 2004 to a median SOTD time of 116min (IQR 60, 205) in 2012, P<0.01 for trend). In subgroup analysis, demographics and the presence of co-morbid conditions did not influence the trend in reperfusion times. However, women had longer reperfusion times than men in 2012. After adjusting for confounding variables, DTB was a significant predictor of in-hospital mortality (HR=1.04 (per 10minutes), P<0.01).

CONCLUSIONS

There was a significant decrease in reperfusion times from 2004 to 2012 in STEMI patients across New York State. This trend was significant regardless of the presence of co-morbid conditions, although a significant gap in reperfusion times persists between men and women.

摘要

背景

登记驱动的数据显示，接受经皮冠状动脉介入治疗（PCI）的ST段抬高型心肌梗死（STEMI）患者的门球时间（DTB）显著缩短。我们试图确定纽约州STEMI患者再灌注时间（症状发作至入院时间（SOTD）和DTB时间）的趋势。

方法

我们回顾性研究了2004年至2012年接受PCI的35613例STEMI患者，并比较了各年份的中位SOTD和DTB时间。排除SOTD时间>12小时和DTB时间>3小时的患者。

结果

DTB时间有统计学意义的缩短趋势（2004年中位DTB时间为83分钟（四分位间距53，116），至2012年中位DTB时间为59分钟（四分位间距40，78），趋势P<0.01）以及SOTD时间（2004年中位SOTD时间为127分钟（四分位间距64，241），至2012年中位SOTD时间为116分钟（四分位间距60，205），趋势P<0.01）。在亚组分析中，人口统计学特征和合并症的存在并未影响再灌注时间的趋势。然而，2012年女性的再灌注时间比男性长。在调整混杂变量后，DTB是住院死亡率的显著预测因素（HR=1.04（每10分钟），P<0.01）。