SAMU 93, UF Recherche-Enseignement-Qualité, Avicenne Hospital-APHP, Bobigny.
Université Paris 13, Sorbonne Paris Cité, Paris.
Eur J Emerg Med. 2019 Dec;26(6):423-427. doi: 10.1097/MEJ.0000000000000586.
Mortality in patients with ST-segment elevation myocardial infarction (STEMI) has been associated with the volume of activity of percutaneous coronary intervention (PCI) facilities. This observational study investigated whether the coronary reperfusion-decision rate is associated with the volume of activity in a prehospital emergency setting.
Prospectively collected data for the period 2003-2013 were extracted from a regional registry of all STEMI patients handled by eight dispatch centers (SAMUs) in and around Paris [41 mobile ICU (MICUs)]. A possible association between volume of activity (number of STEMIs) and coronary reperfusion-decision rate, and subsidiarily between volume of activity and choice of technique (fibrinolysis vs. primary PCI), were investigated. Explanatory factors (patient age, sex, delay between pain onset and first medical contact, and access to a PCI facility) were analyzed in a multivariate analysis.
Overall, 18 162 patients; male/female 3.5/1; median age 62 (52-72) years were included in the analysis. The median number of STEMIs per MICU was 339 (IQ 220-508) and that of reperfusion-decisions was 94% (91-95). There was no association between the decision rate and the number of STEMIs (P = 0.1). However, the decision rate was associated with age, sex, delay, and access to a PCI facility (P < 0.0001) in a highly significant way. Fibrinolysis was a more frequent option for low-volume (remoter PCI facilities) than high-volume MICUs (30 vs. 16%).
The decision of coronary reperfusion in a prehospital emergency setting depended on patient characteristics, delay between pain onset and first medical contact, and access to a PCI facility, but not on volume of activity. Promoting fibrinolysis use in underserved areas might help increase the reperfusion-decision rate.
ST 段抬高型心肌梗死（STEMI）患者的死亡率与经皮冠状动脉介入治疗（PCI）设施的活动量有关。本观察性研究旨在探讨在院前急救环境中，冠状动脉再灌注决策率是否与活动量有关。
从巴黎及其周边地区 8 个调度中心（SAMU）处理的所有 STEMI 患者的区域登记处提取 2003 年至 2013 年期间的前瞻性数据[41 个移动重症监护病房（MICUs）]。研究了活动量（STEMI 数量）与冠状动脉再灌注决策率之间的可能相关性，以及活动量与技术选择（溶栓与直接 PCI）之间的相关性。对解释因素（患者年龄、性别、疼痛发作与首次医疗接触之间的延迟以及 PCI 设施的可及性）进行了多变量分析。
共纳入 18162 例患者，男女比例为 3.5/1；中位年龄 62（52-72）岁。每个 MICU 的 STEMI 中位数为 339（IQR 220-508），再灌注决策的中位数为 94%（91-95）。决策率与 STEMI 数量之间无相关性（P=0.1）。然而，决策率与年龄、性别、延迟和 PCI 设施的可及性显著相关（P<0.0001）。在低容量（距离 PCI 设施较远的地区）MICUs 中，溶栓的选择比高容量 MICUs 更常见（30%比 16%）。
院前急救环境中的冠状动脉再灌注决策取决于患者特征、疼痛发作与首次医疗接触之间的延迟以及 PCI 设施的可及性，但与活动量无关。在服务不足的地区推广溶栓的使用可能有助于提高再灌注决策率。
