Department of Cardiology and Nephrology, Mie University Graduate School of Medicine.
Tokyo CCU Network Scientific Committee.
Circ J. 2018 May 25;82(6):1666-1674. doi: 10.1253/circj.CJ-17-1275. Epub 2018 Mar 27.
There are few reports examining regional differences between rural prefectures and metropolitan areas in the management of acute myocardial infarction (AMI) in Japan.
In the Rural AMI registry, a prospective, multi-prefectural registry of AMI in 4 rural prefectures (Ishikawa, Aomori, Ehime and Mie), a total of 1,695 consecutive AMI patients were registered in 2013. Among them, 1,313 patients who underwent primary percutaneous coronary intervention (PPCI) within 24 h of onset were enrolled in this study (Rural group), and compared with the cohort data from the Tokyo CCU Network registry for AMI in the same period (Metropolitan group, 2,075 patients). The prevalence of direct ambulance transport to PCI-capable facilities in the Rural group was significantly lower than that in the Metropolitan group (43.8% vs. 60.3%, P<0.01), which resulted in a longer onset-to-balloon time (OTB: 225 vs. 210 min, P=0.02) and lower prevalence of PPCI in a timely fashion (OTB ≤2 h: 11.5% vs. 20.7%, P<0.01) in the Rural group. Multivariate analysis revealed that direct ambulance transport was the strongest predictor for PPCI in a timely fashion (odds ratio=4.13, P<0.001).
AMI patients in rural areas were less likely to be transported directly to PCI-capable facilities, resulting in time delay to PPCI compared with those in metropolitan areas.
关于日本急性心肌梗死（AMI）管理中农村县和大都市地区之间的区域差异，鲜有报道对此进行研究。
在农村 AMI 注册研究中，对日本 4 个农村县（石川、青森、爱媛和三重）进行前瞻性、多县 AMI 注册登记，共登记了 1695 例连续 AMI 患者，其中 1313 例患者于发病 24 小时内行直接经皮冠状动脉介入治疗（PPCI），将这些患者纳入本研究（农村组），并与同期东京 CCU 网络 AMI 注册研究的队列数据（大都市组，2075 例）进行比较。农村组直接用救护车转运至可行 PCI 治疗的设施的比例明显低于大都市组（43.8% vs. 60.3%，P<0.01），导致农村组发病至球囊扩张时间（OTB：225 分钟 vs. 210 分钟，P=0.02）较长，及时行 PPCI 的比例较低（OTB≤2 小时：11.5% vs. 20.7%，P<0.01）。多变量分析显示，直接用救护车转运是及时行 PPCI 的最强预测因素（比值比=4.13，P<0.001）。
与大都市地区相比，农村地区的 AMI 患者更不可能被直接转运至可行 PCI 治疗的设施，导致 PPCI 时间延迟。
