Sauser Zachrison Kori, Levine Deborah A, Fonarow Gregg C, Bhatt Deepak L, Cox Margueritte, Schulte Phillip, Smith Eric E, Suter Robert E, Xian Ying, Schwamm Lee H
From the Department of Emergency Medicine (K.S.Z.) and Department of Neurology (L.H.S.), Massachusetts General Hospital and Harvard Medical School, Boston; Department of Internal Medicine, University of Michigan Medical School, Veterans Affairs Center for Clinical Management Research, Institute for Healthcare Policy and Innovation, Ann Arbor (D.A.L.); Division of Cardiology, University of California, Los Angeles (G.C.F.); Brigham and Women's Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Duke Clinical Research Institute, Durham, NC (M.C.); Department of Health Sciences Research, Mayo Clinic, Rochester, MN (P.S.); Hotchkiss Brain Institute, University of Calgary, Alberta, Canada (E.E.S.); The American Heart Association and University of Texas Southwestern, Dallas (R.E.S.); and Duke Clinical Research Institute and Department of Neurology, Duke University Medical Center, Durham, NC (Y.X.).
Circ Cardiovasc Qual Outcomes. 2017 Mar;10(3). doi: 10.1161/CIRCOUTCOMES.116.003148.
Timely reperfusion is critical in acute ischemic stroke (AIS) and ST-segment-elevation myocardial infarction (STEMI). The degree to which hospital performance is correlated on emergent STEMI and AIS care is unknown. Primary objective of this study was to determine whether there was a positive correlation between hospital performance on door-to-balloon (D2B) time for STEMI and door-to-needle (DTN) time for AIS, with and without controlling for patient and hospital differences.
Prospective study of all hospitals in both Get With The Guidelines-Stroke and Get With The Guidelines-Coronary Artery Disease from 2006 to 2009 and treating ≥10 patients. We compared hospital-level DTN time and D2B time using Spearman rank correlation coefficients and hierarchical linear regression modeling. There were 43 hospitals with 1976 AIS and 59 823 STEMI patients. Hospitals' DTN times for AIS did not correlate with D2B times for STEMI (ρ=-0.09; =0.55). There was no correlation between hospitals' proportion of eligible patients treated within target time windows for AIS and STEMI (median DTN time <60 minutes: 21% [interquartile range, 11-30]; median D2B time <90 minutes: 68% [interquartile range, 62-79]; ρ=-0.14; =0.36). The lack of correlation between hospitals' DTN and D2B times persisted after risk adjustment. We also correlated hospitals' DTN time and D2B time data from 2013 to 2014 using Get With The Guidelines (DTN time) and Hospital Compare (D2B time). From 2013 to 2014, hospitals' DTN time performance in Get With The Guidelines was not correlated with D2B time performance in Hospital Compare (n=546 hospitals).
We found no correlation between hospitals' observed or risk-adjusted DTN and D2B times. Opportunities exist to improve hospitals' performance of time-critical care processes for AIS and STEMI in a coordinated approach.
及时再灌注在急性缺血性卒中（AIS）和ST段抬高型心肌梗死（STEMI）中至关重要。医院在急诊STEMI和AIS治疗方面的表现之间的相关程度尚不清楚。本研究的主要目的是确定在控制和不控制患者及医院差异的情况下，医院在STEMI的门球时间（D2B）和AIS的门针时间（DTN）方面的表现是否存在正相关。
对2006年至2009年参与“遵循指南-卒中”和“遵循指南-冠状动脉疾病”项目且治疗≥10例患者的所有医院进行前瞻性研究。我们使用Spearman等级相关系数和分层线性回归模型比较医院层面的DTN时间和D2B时间。有43家医院，共1976例AIS患者和59823例STEMI患者。医院的AIS的DTN时间与STEMI的D2B时间不相关（ρ=-0.09；P=0.55）。医院在AIS和STEMI的目标时间窗内治疗的符合条件患者比例之间没有相关性（中位DTN时间<60分钟：21%[四分位间距，11%-30%]；中位D2B时间<90分钟：68%[四分位间距，62%-79%]；ρ=-0.14；P=0.36）。在风险调整后，医院的DTN和D2B时间之间缺乏相关性仍然存在。我们还使用“遵循指南”（DTN时间）和“医院比较”（D2B时间）对2013年至2014年医院的DTN时间和D2B时间数据进行了相关性分析。2013年至2014年，“遵循指南”中医院的DTN时间表现与“医院比较”中的D2B时间表现不相关（n=546家医院）。
我们发现医院观察到的或经风险调整的DTN和D2B时间之间没有相关性。存在以协调的方式改善医院对AIS和STEMI的时间关键型治疗流程表现的机会。
