Stassen Willem, Wallis Lee, Vincent-Lambert Craig, Castren Maaret, Kurland Lisa
Department of Clinical Research and Education, Karolinska Institute, Stockholm, Sweden; and Division of Emergency Medicine, Stellenbosch University, Stellenbosch, South Africa. Email:
Division of Emergency Medicine, Stellenbosch University, Stellenbosch, South Africa.
Cardiovasc J Afr. 2018 Jan/Feb;29(1):6-11. doi: 10.5830/CVJA-2018-004.
Timely reperfusion, preferably via percutaneous coronary intervention (PCI) following myocardial infarction, improves mortality rates. Emergency medical services play a pivotal role in recognising and transporting patients with ST-elevation myocardial infarction directly to a PCI facility to avoid delays to reperfusion. Access to PCI is, in part, dependant on the geographic distribution of patients around PCI facilities. The aim of this study was to determine the proportion of South Africans living within 60 and 120 minutes of a PCI facility.
PCI facility and population data were subjected to proximity analysis to determine the average drive times from municipal ward centroids to PCI facilities for each province in South Africa. Thereafter, the population of each ward living within 60 and 120 minutes of a PCI facility was extrapolated.
Approximately 53.8 and 71.53% of the South African population live within 60 and 120 minutes of a PCI facility. The median (IQR, range) drive times and distances to a PCI facility are 100 minutes (120.4 min, 0.7-751.8) across 123.6 km (157.6 km, 0.3-940.8).
Based on the proximity of South Africans to PCI facilities, it seems possible that most patients could receive timely PCI within 120 minutes of first medical contact. However, this may be unlikely for some due to a lack of medical insurance, under-developed referral networks or other system delays. Coronary care networks should be developed based on the proximity of communities to 12-lead ECG and reperfusion therapies (such as PCI facilities). Public and private healthcare partnerships should be fortified to allow for patients without medical insurance to have equal accesses to PCI facilities.
心肌梗死后及时再灌注，最好是通过经皮冠状动脉介入治疗（PCI），可提高死亡率。紧急医疗服务在识别和将ST段抬高型心肌梗死患者直接转运至PCI机构以避免再灌注延迟方面发挥着关键作用。能否获得PCI治疗部分取决于PCI机构周围患者的地理分布情况。本研究的目的是确定居住在距PCI机构60分钟和120分钟车程范围内的南非人的比例。
对PCI机构和人口数据进行邻近性分析，以确定南非每个省份从市政病房中心到PCI机构的平均驾车时间。此后，推算出居住在距PCI机构60分钟和120分钟车程范围内的每个病房的人口数。
约53.8%和71.53%的南非人口居住在距PCI机构60分钟和120分钟车程范围内。到PCI机构的驾车时间中位数（四分位间距，范围）和距离分别为100分钟（120.4分钟，0.7 - 751.8），跨越123.6公里（157.6公里，0.3 - 940.8）。
基于南非人与PCI机构的接近程度，大多数患者似乎有可能在首次医疗接触后的120分钟内接受及时的PCI治疗。然而，由于缺乏医疗保险、转诊网络不发达或其他系统延误，对一些人来说这可能不太可能。应根据社区与12导联心电图和再灌注治疗（如PCI机构）的接近程度来建立冠心病护理网络。应加强公共和私立医疗保健伙伴关系，以使没有医疗保险的患者能够平等地获得PCI机构的治疗。
