Duke Clinical Research Institute, Durham, NC
Duke Clinical Research Institute, Durham, NC.
J Am Heart Assoc. 2017 Oct 11;6(10):e005717. doi: 10.1161/JAHA.117.005717.
Patients with ST-elevation myocardial infarction (STEMI) with out-of-hospital cardiac arrest (OHCA) may benefit from direct transport to a percutaneous cardiac intervention (PCI) hospital but have previously been less likely to bypass local non-PCI hospitals to go to a PCI center.
We reported time trends in emergency medical service transport and care of patients with STEMI with and without OHCA included from 171 PCI-capable hospitals in 16 US regions with participation in the Mission: Lifeline STEMI Accelerator program between July 1, 2012, and March 31, 2014. Time trends by quarter were assessed using logistic regression with generalized estimating equations to account for hospital clustering. Of 13 189 emergency medical service-transported patients, 88.7% (N=11 703; 10.5% OHCA) were taken directly to PCI hospitals. Among 1486 transfer-in patients, 21.7% had OHCA. Direct transport to a PCI center for OHCA increased from 74.7% (July 1, 2012) to 83.6% (March 31, 2014) (odds ratio per quarter, 1.07; 95% confidence interval, 1.02-1.14), versus 89.0% to 91.0% for patients without OHCA (odds ratio, 1.03; 95% confidence interval, 0.99-1.07; interaction =0.23). The proportion with prehospital ECGs increased for patients taken directly to PCI centers (53.9%-61.9% for those with OHCA versus 73.9%-81.9% for those without OHCA; interaction =0.12). Of 997 patients with OHCA taken directly to PCI hospitals and treated with primary PCI, first medical contact-to-device times within the guideline-recommended goal of ≤90 minutes were met for 34.5% on July 1, 2012, versus 41.8% on March 31, 2014 (51.6% and 56.1%, respectively, for 9352 counterparts without OHCA; interaction =0.72).
Direct transport to PCI hospitals increased for patients with STEMI with and without OHCA during the 2012 to 2014 Mission: Lifeline STEMI Accelerator program. Proportions with prehospital ECGs and timely reperfusion increased for patients taken directly to PCI hospitals.
ST 段抬高型心肌梗死（STEMI）伴院外心脏骤停（OHCA）的患者可能受益于直接转运至经皮冠状动脉介入（PCI）医院，但此前他们更有可能绕过当地非 PCI 医院，直接转运至 PCI 中心。
我们报告了 2012 年 7 月 1 日至 2014 年 3 月 31 日期间，16 个美国地区的 171 家具备 PCI 能力的医院参与 Mission: Lifeline STEMI 加速计划期间，STEMI 伴或不伴 OHCA 患者的急诊医疗服务转运和治疗的时间趋势。使用广义估计方程的逻辑回归评估按季度的时间趋势，以考虑医院聚类。在 13189 例经急诊医疗服务转运的患者中，88.7%（N=11703；10.5% OHCA）直接转运至 PCI 医院。在 1486 例转入患者中，21.7%有 OHCA。直接转运至 PCI 中心治疗 OHCA 的比例从 2012 年 7 月 1 日的 74.7%增加到 2014 年 3 月 31 日的 83.6%（每季度比值，1.07；95%置信区间，1.02-1.14），而对于无 OHCA 的患者则从 89.0%增加到 91.0%（比值，1.03；95%置信区间，0.99-1.07；交互作用=0.23）。直接转运至 PCI 中心的患者中，行院前心电图检查的比例增加（有 OHCA 的患者为 53.9%-61.9%，无 OHCA 的患者为 73.9%-81.9%；交互作用=0.12）。在直接转运至 PCI 医院并接受直接 PCI 治疗的 997 例 OHCA 患者中，首次医疗接触至器械时间达到指南推荐的≤90 分钟目标的比例，2012 年 7 月 1 日为 34.5%，2014 年 3 月 31 日为 41.8%（无 OHCA 的 9352 例患者分别为 51.6%和 56.1%；交互作用=0.72）。
在 2012 年至 2014 年 Mission: Lifeline STEMI 加速计划期间，STEMI 伴或不伴 OHCA 患者直接转运至 PCI 医院的比例增加。直接转运至 PCI 医院的患者中，行院前心电图检查和及时再灌注的比例增加。
