Duke University Medical Center, Durham, NC.
Duke Clinical Research Institute, Durham, NC.
J Am Heart Assoc. 2017 Oct 24;6(10):e007122. doi: 10.1161/JAHA.117.007122.
The American Heart Association Mission: Lifeline STEMI (ST-segment-elevation myocardial infarction) Systems Accelerator program, conducted in 16 regions across the United States to improve key care processes, resulted in more patients being treated within national guideline goals (time from first medical contact to device: <90 minutes for direct presenters to hospitals capable of performing percutaneous coronary intervention; <120 minutes for transfers). We examined whether the effort reduced reperfusion disparities in the proportions of female versus male and black versus white patients.
In total, 23 809 patients (29.3% female, 82.3% white, and 10.7% black) presented with acute STEMI between July 2012 and March 2014. Change in the proportion of patients treated within guideline goals was compared between sex and race subgroups for patients presenting directly to hospitals capable of performing percutaneous coronary intervention (n=18 267) and patients requiring transfer (n=5542). The intervention was associated with an increase in the proportion of men treated within guideline goals that presented directly (58.7-62.1%, =0.01) or were transferred (43.3-50.7%, <0.01). An increase was also seen among white patients who presented directly (57.7-59.9%, =0.02) or were transferred (43.9-48.8%, <0.01). There was no change in the proportion of female or black patients treated within guideline goals, including both those presenting directly and transferred.
The STEMI Systems Accelerator project was associated with an increase in the proportion of patients meeting guideline reperfusion targets for male and white patients but not for female or black patients. Efforts to organize systems of STEMI care should implement additional processes targeting barriers to timely reperfusion among female and black patients.
美国心脏协会使命：生命线 STEMI（ST 段抬高型心肌梗死）系统加速器计划在美国 16 个地区开展，旨在改善关键护理流程，使更多患者能够在符合国家指南目标的时间内得到治疗（从首次医疗接触到器械的时间：直接就诊于能够进行经皮冠状动脉介入治疗的医院的患者<90 分钟；需要转院的患者<120 分钟）。我们研究了这一努力是否减少了女性与男性、黑种人与白种人患者在再灌注方面的差异。
共有 23809 例（29.3%为女性，82.3%为白种人，10.7%为黑种人）于 2012 年 7 月至 2014 年 3 月期间出现急性 STEMI。比较了直接就诊于能够进行经皮冠状动脉介入治疗的医院的患者（n=18267）和需要转院的患者（n=5542）中，按性别和种族亚组，比较指南目标内治疗比例的变化。干预措施与直接就诊（58.7%-62.1%，<0.01）或转院（43.3%-50.7%，<0.01）的男性患者接受指南治疗的比例增加相关。白种人直接就诊（57.7%-59.9%，=0.02）或转院（43.9%-48.8%，<0.01）的患者比例也有所增加。而女性或黑种患者接受指南治疗的比例没有变化，包括直接就诊和转院的患者。
STEMI 系统加速器项目与符合男性和白种人指南再灌注目标的患者比例增加相关，但不符合女性或黑种人患者的目标。为组织 STEMI 护理系统而开展的工作，应实施额外的流程，以解决女性和黑种人患者及时再灌注的障碍。
