Callachan Edward L, Alsheikh-Ali Alawi A, Nair Satish Chandrasekhar, Bruijns Stevan, Wallis Lee A
University of Cape Town, Department of Surgery, Division of Emergency Medicine, Bellville, South Africa.
Mohammed Bin Rashid University of Medicine and Health Sciences, College of Medicine, Dubai, United Arab Emirates.
West J Emerg Med. 2017 Apr;18(3):349-355. doi: 10.5811/westjem.2017.1.32593. Epub 2017 Mar 13.
The purpose of this multicenter study was to assess differences in demographics, medical history, treatment times, and follow-up status among patients with ST-elevation myocardial infarction (STEMI), who were transported to the hospital by emergency medical services (EMS) or by private vehicle, or were transferred from other medical facilities.
This multicenter study involved the collection of both retrospective and prospective data from 455 patients admitted to four hospitals in Abu Dhabi. We collected electronic medical records from EMS and hospitals, and conducted interviews with patients in person or via telephone. Chi-square tests and Kruskal-Wallis tests were used to examine differences in variables by mode of transportation.
Results indicated significant differences in modes of transportation when considering symptom-onset-to-balloon time (p < 0.001), door-to-balloon time (p < 0.001), and health status at six-month and one-year follow-up (p < 0.001). Median times (interquartile range) for patients transported by EMS, private vehicle, or transferred from an outside facility were as follows: symptom-onset-to-balloon time in hours, 3.1 (1.8-4.3), 3.2 (2.1-5.3), and 4.5 (3.0-7.5), respectively; door-to-balloon time in minutes, 70 (48-78), 81 (64-105), and 62 (46-77), respectively. In all cases, EMS transportation was associated with a shorter time to treatment than other modes of transportation. However, the EMS group experienced greater rates of in-hospital events, including cardiac arrest and mortality, than the private transport group.
Our results contribute data supporting EMS transportation for patients with acute coronary syndrome. Although a lack of follow-up data made it difficult to draw conclusions about long-term outcomes, our findings clearly indicate that EMS transportation can speed time to treatment, including time to balloon inflation, potentially reducing readmission and adverse events. We conclude that future efforts should focus on encouraging the use of EMS and improving transfer practices. Such efforts could improve outcomes for patients presenting with STEMI.
这项多中心研究的目的是评估通过紧急医疗服务（EMS）、私家车运送或从其他医疗机构转诊至医院的ST段抬高型心肌梗死（STEMI）患者在人口统计学、病史、治疗时间和随访状态方面的差异。
这项多中心研究收集了来自阿布扎比四家医院455例住院患者的回顾性和前瞻性数据。我们从EMS和医院收集电子病历，并亲自或通过电话对患者进行访谈。采用卡方检验和Kruskal-Wallis检验来检验不同运输方式下变量的差异。
结果表明，在考虑症状发作至球囊扩张时间（p < 0.001）、门到球囊扩张时间（p < 0.001）以及六个月和一年随访时的健康状况（p < 0.001）方面，运输方式存在显著差异。由EMS运送、私家车运送或从外部机构转诊的患者的中位时间（四分位间距）如下：症状发作至球囊扩张时间（小时）分别为3.1（1.8 - 4.3）、3.2（2.1 - 5.3）和4.5（3.0 - 7.5）；门到球囊扩张时间（分钟）分别为70（48 - 78）、81（64 - 105）和62（46 - 77）。在所有情况下，与其他运输方式相比，EMS运送与更短的治疗时间相关。然而，EMS组的院内事件发生率，包括心脏骤停和死亡率，高于私家车运送组。
我们的结果为支持急性冠状动脉综合征患者使用EMS运送提供了数据。尽管缺乏随访数据使得难以得出关于长期结局的结论，但我们的研究结果清楚地表明，EMS运送可以加快治疗时间，包括球囊扩张时间，可能减少再入院和不良事件。我们得出结论，未来的努力应集中在鼓励使用EMS和改善转诊流程上。这些努力可以改善STEMI患者的预后。
