Tsukui Takunori, Sakakura Kenichi, Taniguchi Yousuke, Yamamoto Kei, Wada Hiroshi, Momomura Shin-Ichi, Fujita Hideo
Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan.
Heart Vessels. 2018 May;33(5):498-506. doi: 10.1007/s00380-017-1089-x. Epub 2017 Nov 20.
Primary percutaneous coronary interventions (PCI) have been developed to improve clinical outcomes in patients with ST-segment elevation myocardial infarction (STEMI). In primary PCI, the door-to-balloon time (DTBT) is closely associated with mortality and morbidity. The purpose of this study was to find determinants of short and long DTBT. From our hospital record, we included 214 STEMI patients, and divided into the short DTBT group (DTBT < 60 min, n = 60), the intermediate DTBT group (60 min ≤ DTBT ≤ 120 min, n = 121) and the long DTBT group (DTBT > 120 min, n = 33). In-hospital mortality was highest in the long DTBT group (24.2%), followed by the intermediate DTBT group (5.8%), and lowest in the short DTBT group (0%) (< 0.001). Transfers from local clinics or hospitals (OR 3.43, 95% CI 1.72-6.83, P < 0.001) were significantly associated with short DTBT, whereas Killip class 3 or 4 (vs. Killip class 1 or 2: OR 0.20, 95% CI 0.06-0.64, P = 0.007) was inversely associated with short DTBT in multivariate analysis. In conclusion, transfer from local clinics/hospitals was associated with short DTBT. Our results may suggest the current limitation of ambulance system, which does not include pre-hospital ECG system, in Japan. The development of pre-hospital ECG system would be needed for better management in STEMI.
直接经皮冠状动脉介入治疗（PCI）已被用于改善ST段抬高型心肌梗死（STEMI）患者的临床结局。在直接PCI中，门球时间（DTBT）与死亡率和发病率密切相关。本研究的目的是找出短DTBT和长DTBT的决定因素。从我们医院的记录中，我们纳入了214例STEMI患者，并将其分为短DTBT组（DTBT＜60分钟，n = 60）、中DTBT组（60分钟≤DTBT≤120分钟，n = 121）和长DTBT组（DTBT＞120分钟，n = 33）。长DTBT组的院内死亡率最高（24.2%），其次是中DTBT组（5.8%），短DTBT组最低（0%）（＜0.001）。从当地诊所或医院转诊（比值比3.43，95%可信区间1.72 - 6.83，P＜0.001）与短DTBT显著相关，而在多变量分析中，Killip分级3或4级（与Killip分级1或2级相比：比值比0.20，95%可信区间0.06 - 0.64，P = 0.007）与短DTBT呈负相关。总之，从当地诊所/医院转诊与短DTBT相关。我们的结果可能提示了日本目前急救系统的局限性，该系统不包括院前心电图系统。为了更好地管理STEMI，需要开发院前心电图系统。
