Kerr Andrew, Lee Mildred, Grey Corina, Pegg Tammy, Fisher Nick, White Harvey, Nunn Chris, Williams Michael, Smyth David, Scott Tony, Chen Rachel, Zhao Jinfeng, Tun Thu Rein, Harwood Matire, Devlin Gerry
Cardiologist, Middlemore Hospital, Auckland; Department of Medicine, Auckland School of Medicine, Auckland.
Health Analyst, Department of Cardiology, Middlemore Hospital, Auckland.
N Z Med J. 2019 Jul 12;132(1498):41-59.
Prompt access to cardiac defibrillation and reperfusion therapy improves outcomes in patients with ST-segment elevation myocardial infarction (STEMI). The study aim was to describe the 'patient' and 'system' delay in patients who receive acute reperfusion therapy for ST-elevation myocardial infarction (STEMI) in New Zealand.
In 2015-17, 3,857 patients who received acute reperfusion therapy were captured in the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry. 'Patient delay' is the time from symptom onset to first medical contact (FMC), and 'system delay' the time from FMC until reperfusion therapy (primary percutaneous coronary intervention (PCI) or fibrinolysis).
Seventy percent of patients received primary PCI and 30% fibrinolysis. Of those receiving fibrinolysis, 122 (10.5%) received pre-hospital fibrinolysis. Seventy-seven percent were transported to hospital by ambulance. After adjustment, people who were older, male and presented to a hospital without a routine primary PCI service were less likely to travel by ambulance. Patient delay: The median delay was 45 minutes for ambulance-transported patients and 97 minutes for those self-transported to hospital, with a quarter delayed by >2 hours and >3 hours, respectively. Delay >1 hour was more common in older patients, Māori and Indian patients and those self-transported to hospital. System delay: For ambulance-transported patients who received primary PCI, the median time was 119 minutes. For ambulance-transported patients who received fibrinolysis, the median system delay was 86 minutes, with Māori patients more often delayed than European/Other patients. For patients who received pre-hospital fibrinolysis the median delay was 46 minutes shorter. For the quarter of patients treated with rescue PCI after fibrinolysis, the median needle-to-rescue time was prolonged-four hours.
Nationwide implementation of the NZ STEMI pathway is needed to reduce system delays in delivery of primary PCI, fibrinolysis and rescue PCI. Ongoing initiatives are required to reduce barriers to calling the ambulance early after symptom onset.
及时获得心脏除颤和再灌注治疗可改善ST段抬高型心肌梗死（STEMI）患者的预后。本研究旨在描述新西兰接受ST段抬高型心肌梗死（STEMI）急性再灌注治疗患者的“患者延误”和“系统延误”情况。
2015年至2017年期间，全新西兰急性冠状动脉综合征质量改进（ANZACS-QI）登记处记录了3857例接受急性再灌注治疗的患者。“患者延误”是指从症状发作到首次医疗接触（FMC）的时间，“系统延误”是指从FMC到再灌注治疗（主要是经皮冠状动脉介入治疗（PCI）或溶栓治疗）的时间。
70%的患者接受了主要PCI治疗，30%接受了溶栓治疗。在接受溶栓治疗的患者中，122例（10.5%）接受了院前溶栓治疗。77%的患者通过救护车转运至医院。经过调整后，年龄较大、男性且就诊于没有常规主要PCI服务医院的患者乘坐救护车的可能性较小。患者延误：乘坐救护车的患者中位延误时间为45分钟，自行前往医院的患者为97分钟，分别有四分之一的患者延误超过2小时和3小时。延误超过1小时在老年患者、毛利人和印度患者以及自行前往医院的患者中更为常见。系统延误：对于乘坐救护车接受主要PCI治疗的患者，中位时间为119分钟。对于乘坐救护车接受溶栓治疗的患者，中位系统延误为86分钟，毛利患者比欧洲/其他患者更常出现延误。对于接受院前溶栓治疗的患者，中位延误时间缩短46分钟。对于溶栓后接受补救性PCI治疗的四分之一患者，中位穿刺至补救时间延长至4小时。
需要在全国范围内实施新西兰STEMI治疗路径，以减少主要PCI、溶栓和补救性PCI治疗中的系统延误。需要持续开展相关举措，以减少症状发作后尽早呼叫救护车的障碍。
