Alnsasra Hilmi, Zahger Doron, Geva Diklah, Matetzky Shlomi, Beigel Roy, Iakobishvili Zaza, Alcalai Ronny, Atar Shaul, Shimony Avi
Department of Cardiology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
Department of Cardiology, Sheba Medical Center, Tel-Hashomer, Sackler school of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
Am J Cardiol. 2017 Nov 15;120(10):1715-1719. doi: 10.1016/j.amjcard.2017.07.085. Epub 2017 Aug 8.
Treatment delays in patients with acute myocardial infarction (AMI) are related to increased morbidity and mortality. Hence, identifying determinants of delay may help reduce time to treatment. Importantly, limited data suggest that there may be sex-related disparities in benchmark timelines. Although guidelines advocate the use of the first medical contact (FMC) rather than hospital admission as the moment from which delays to treatment should be monitored, the latter is still often used for quality purposes. We aimed to identify factors associated with treatment delays, with an emphasis on sex-related disparities. We reviewed data on 3,658 patients with AMI from 2 contemporary, consecutive multicenter surveys. Measured delays were FMC-to-electrocardiogram >10 minutes in ST-elevation MI (STEMI) and non-STEMI, FMC-to-primary percutaneous coronary intervention >90 minutes in STEMI, and invasive angiography >72 hours after admission in non-STEMI patients. Timely electrocardiogram was performed in 48% of patients with STEMI and in 39.8% of non-STEMI patients without significant sex-related differences. Independent determinants of delay included atypical chest pain (CP) and presentation during daytime. In patients with STEMI, 37.5% had primary percutaneous coronary intervention in less than 90 minutes without significant sex-related disparities. Independent determinants of delay included atypical CP, night presentation, and diabetes. In non-STEMI patients, independent determinants of delayed invasive approach were female sex, age >75 years, atypical CP, and renal failure. In conclusion, significant treatment delays in patients with AMI are still frequent in contemporary practice, highlighting the need for improvement and guidelines implementation. Predictors of delay identified in our study may facilitate targeting of interventions to improve adherence to guidelines.
急性心肌梗死（AMI）患者的治疗延迟与发病率和死亡率增加相关。因此，确定延迟的决定因素可能有助于缩短治疗时间。重要的是，有限的数据表明，在基准时间线上可能存在性别差异。尽管指南提倡以首次医疗接触（FMC）而非住院作为监测治疗延迟的起点，但后者仍经常用于质量评估目的。我们旨在确定与治疗延迟相关的因素，重点关注性别差异。我们回顾了来自两项当代连续多中心调查的3658例AMI患者的数据。测量的延迟情况为：ST段抬高型心肌梗死（STEMI）和非STEMI患者中FMC至心电图时间>10分钟，STEMI患者中FMC至直接经皮冠状动脉介入治疗时间>90分钟，非STEMI患者入院后侵入性血管造影时间>72小时。STEMI患者中有48%以及非STEMI患者中有39.8%及时进行了心电图检查，且无显著的性别差异。延迟的独立决定因素包括非典型胸痛（CP）和白天就诊。在STEMI患者中，37.5%的患者在不到90分钟内接受了直接经皮冠状动脉介入治疗，且无显著的性别差异。延迟的独立决定因素包括非典型CP、夜间就诊和糖尿病。在非STEMI患者中，延迟侵入性治疗方法的独立决定因素为女性、年龄>75岁、非典型CP和肾衰竭。总之，在当代实践中，AMI患者的显著治疗延迟仍然很常见，这凸显了改进和实施指南的必要性。我们研究中确定的延迟预测因素可能有助于针对性地进行干预，以提高对指南的依从性。
