Dakota Iwan, Dharma Surya, Andriantoro Hananto, Firdaus Isman, Danny Siska Suridanda, Zamroni Dian, Radi Basuni
Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, National Cardiovascular Center Harapan Kita, West Jakarta, Indonesia.
Int J Angiol. 2020 Mar;29(1):27-32. doi: 10.1055/s-0039-3401046. Epub 2019 Dec 27.
Routine performance measures of primary percutaneous coronary intervention (PCI) within an ST-segment elevation myocardial infarction (STEMI) network are needed to improve care. We evaluated the door-in to door-out (DI-DO) delays at the initial hospitals in STEMI patients as a routine performance measure of the metropolitan STEMI network. We retrospectively analyzed the DI-DO time from 1,076 patients with acute STEMI who were transferred by ground ambulance to a primary PCI center for primary PCI between 4 October 2014 and 1 April 2019. Correlation analysis between DI-DO times and total ischemia time was performed using Spearman's test. Logistic regression analyses were used to find variables associated with a longer DI-DO time. Median DI-DO time was 180 minutes (25th percentile to 75th percentile: 120-252 minutes). DI-DO time showed a positive correlation with total ischemia time ( = 0.4, < 0.001). The median door-to-device time at the PCI center was 70 minutes (25th percentile to 75th percentile: 58-88 minutes). Multivariate analysis showed that women patients were independently associated with DI-DO time > 120 minutes (odds ratio 1.55, 95% confidence interval 1.03 to 2.33, = 0.03). The DI-DO time reported in this study has not reached the guideline recommendation. To improve the overall performance of primary PCI in the region, interventions aimed at improving the DI-DO time at the initial hospitals and specific threat for women patients with STEMI are possibly the best efforts in improving the total ischemia time.
需要采用ST段抬高型心肌梗死（STEMI）网络中直接经皮冠状动脉介入治疗（PCI）的常规性能指标来改善治疗。我们评估了STEMI患者在初始医院的进门到出门（DI-DO）延迟，将其作为大都市STEMI网络的常规性能指标。我们回顾性分析了2014年10月4日至2019年4月1日期间，1076例急性STEMI患者经地面救护车转运至初级PCI中心进行初级PCI的DI-DO时间。使用Spearman检验进行DI-DO时间与总缺血时间之间的相关性分析。采用逻辑回归分析来寻找与较长DI-DO时间相关的变量。DI-DO时间中位数为180分钟（第25百分位数至第75百分位数：120 - 252分钟）。DI-DO时间与总缺血时间呈正相关（r = 0.4，P < 0.001）。PCI中心的门到器械时间中位数为70分钟（第25百分位数至第75百分位数：58 - 88分钟）。多变量分析显示，女性患者与DI-DO时间>120分钟独立相关（比值比1.55，95%置信区间1.03至2.33，P = 0.03）。本研究报告的DI-DO时间未达到指南推荐。为提高该地区初级PCI的整体性能，旨在缩短初始医院DI-DO时间的干预措施以及针对STEMI女性患者的特定措施可能是改善总缺血时间的最佳努力方向。
