Meisel Simcha R, Kleiner-Shochat Michael, Frimerman Aaron, Levy Yaniv, Abu Fanne Rami, Amsalem Naama, Bar El Maguli, Hochman Ohad, Ashkar Jalal, Asif Aya, Mohsen Jameel, Zidan Adham, Neiman Elena, Samara Hazem, Kazatsker Mark, Blondheim David S, Shotan Avraham
Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel, affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa - Israel.
Hospital Management, Hillel Yaffe Medical Center, Hadera, Israel, affiliated to the Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa - Israel.
Harefuah. 2019 Jan;158(1):35-40.
Shortening door-to-balloon time intervals in ST-elevation myocardial infarction (STEMI) patients treated by primary percutaneous coronary intervention (PPCI) is necessary in order to limit myocardial damage. Direct admission to the cardiac care unit (CCU) facilitates this goal. We compared characteristics and short- and long-term mortality of PPCI-treated STEMI patients admitted directly to the CCU with those admitted via the emergency department (ED).
To compare 303 patients admitted directly to the CCU (42%) with 427 admitted via the ED (58%) included in the current registry comprising 730 consecutive PPCI-treated STEMI patients.
Groups were similar regarding demographics, medical history and risk factors. Pain-to-CCU time was 151±164 minutes (median-94) for patients admitted directly and 242±226 minutes (160) for those admitted via the ED, while door-to-balloon intervals were 69±42 minutes (61) and 133±102 minutes (111), respectively. LVEF evaluated during admission (48.3±13% [47.5%] vs. 47.7±13.7% [47.5%]) and mean CK level (893±1157 [527] vs. 891±1255 [507], p=0.45) were similar between groups. Mortality was 4.2% vs. 10.3% at 30-days (p<0.002), 7.6% and 14.3% at one-year (p<0.01), reaching 12.2% and 21.9% at 3.9±2.3 years (median-3.5, p<0.004) among directly-admitted patients vs. those admitted via the ED, respectively. Long-term mortality was 4.1%, 9.4%, 21.4%, and 16% for pain-to-balloon quartiles of <140 min, 141-207 min, 208-330 min, and >330 mins, respectively (p=0.026).
Direct admission of STEMI patients to the CCU for PPCI facilitated the attainment of guidelines-dictated door-to-balloon time intervals and yielded improved short- and long-term mortality. Longer pain-to-balloon time was associated with higher long-term mortality.
对于接受直接经皮冠状动脉介入治疗（PPCI）的ST段抬高型心肌梗死（STEMI）患者，缩短球囊扩张时间间隔对于限制心肌损伤至关重要。直接入住心脏监护病房（CCU）有助于实现这一目标。我们比较了直接入住CCU的接受PPCI治疗的STEMI患者与通过急诊科（ED）入院的患者的特征以及短期和长期死亡率。
在当前登记的730例连续接受PPCI治疗的STEMI患者中，比较直接入住CCU的303例患者（42%）与通过ED入院的427例患者（58%）。
两组在人口统计学、病史和危险因素方面相似。直接入院患者的疼痛至CCU时间为151±164分钟（中位数94分钟），通过ED入院患者为242±226分钟（160分钟），而球囊扩张时间间隔分别为69±42分钟（61分钟）和133±102分钟（111分钟）。入院时评估的左心室射血分数（LVEF）（48.3±13% [47.5%] 对 47.7±13.7% [47.5%]）和平均肌酸激酶水平（893±1157 [527] 对 891±1255 [507]，p = 0.45）在两组之间相似。30天时死亡率分别为4.2%和10.3%（p<0.002），1年时为7.6%和14.3%（p<0.01），在直接入院患者与通过ED入院患者中，3.9±2.3年（中位数3.5年，p<0.004）时分别达到12.2%和21.9%。疼痛至球囊时间四分位数<140分钟、141 - 207分钟、208 - 330分钟和>330分钟的长期死亡率分别为4.1%、9.4%、21.4%和16%（p = 0.026）。
STEMI患者直接入住CCU进行PPCI有助于达到指南规定的球囊扩张时间间隔，并改善短期和长期死亡率。较长的疼痛至球囊时间与较高的长期死亡率相关。
