Cardiology Department, Les Hôpitaux de Chartres, France.
Emergency Unit Department, Les Hôpitaux de Chartres, France.
Eur Heart J Acute Cardiovasc Care. 2020 Dec;9(8):958-965. doi: 10.1177/2048872619848976. Epub 2019 Aug 31.
The aim of this study was to analyse delays in emergency medical system transfer of ST-segment elevation myocardial infarction (STEMI) patients to percutaneous coronary intervention (PCI) centres according to transport modality in a rural French region.
Data from the prospective multicentre CRAC / France PCI registry were analysed for 1911 STEMI patients: 410 transferred by helicopter and 1501 by ground transport. The primary endpoint was the percentage of transfers with first medical contact to primary percutaneous coronary intervention within the 90 minutes recommended in guidelines. The secondary endpoint was time of first medical contact to primary percutaneous coronary intervention. With helicopter transport, time of first medical contact to primary percutaneous coronary intervention in under 90 minutes was less frequently achieved than with ground transport (9.8% vs. 37.2%; odds ratio 5.49; 95% confidence interval 3.90; 7.73; <0.0001). Differences were greatest for transfers under 50 km (13.7% vs. 44.7%; <0.0001) and for primary transfers (22.4% vs. 49.6%; <0.0001). The median time from first medical contact to primary percutaneous coronary intervention and from symptom onset to primary percutaneous coronary intervention (total ischaemic time) were significantly higher in the helicopter transport group than in the ground transport group (respectively, 137 vs. 103 minutes; <0.0001 and 261 vs. 195 minutes; <0.0001). There was no significant difference in inhospital mortality between the helicopter and ground transport groups (6.9% vs. 6.6%; =0.88).
Helicopter transport of STEMI patients was five times less effective than ground transport in maintaining the 90-minute first medical contact to primary percutaneous coronary intervention time recommended in guidelines, particularly for transfer distances less than 50 km.
本研究旨在分析法国某农村地区根据转运方式，ST 段抬高型心肌梗死（STEMI）患者经急救医疗系统转至经皮冠状动脉介入治疗（PCI）中心的延迟情况。
对前瞻性多中心 CRAC/法国 PCI 注册研究的 1911 例 STEMI 患者的数据进行了分析：410 例患者通过直升机转运，1501 例患者通过地面转运。主要终点是符合指南推荐的 90 分钟内首次医疗接触至直接经皮冠状动脉介入治疗的患者比例。次要终点是首次医疗接触至直接经皮冠状动脉介入治疗的时间。与地面转运相比，直升机转运患者在 90 分钟内实现首次医疗接触至直接经皮冠状动脉介入治疗的比例较低（9.8%比 37.2%；比值比 5.49；95%置信区间 3.90~7.73；<0.0001）。转运距离小于 50km 时差异最大（13.7%比 44.7%；<0.0001），而直接转运时差异最大（22.4%比 49.6%；<0.0001）。直升机转运组从首次医疗接触至直接经皮冠状动脉介入治疗的中位数时间和从症状发作至直接经皮冠状动脉介入治疗的中位数时间（总缺血时间）均显著长于地面转运组（分别为 137 比 103 分钟；<0.0001 和 261 比 195 分钟；<0.0001）。直升机转运组与地面转运组的院内死亡率无显著差异（6.9%比 6.6%；=0.88）。
与地面转运相比，直升机转运 STEMI 患者维持指南推荐的 90 分钟内首次医疗接触至直接经皮冠状动脉介入治疗时间的效果差 5 倍，特别是转运距离小于 50km 时。
