Saberian Peyman, Tavakoli Nader, Hasani-Sharamin Parisa, Sezavar Seyed Hashem, Dadashi Fatemeh, Vahidi Elnaz
Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Department of Anesthesiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Turk J Emerg Med. 2020 Jan 28;20(1):28-34. doi: 10.4103/2452-2473.276380. eCollection 2020 Jan-Mar.
The sooner the primary percutaneous coronary intervention (PPCI) is performed, the better prognosis is expected in patients with acute myocardial infarction. The objective is to evaluate the effect of prehospital triage based on electrocardiogram (ECG) and telecardiology on the mortality and morbidity of ST-segment elevated myocardial infarction (STEMI) patients undergoing PPCI.
This cross-sectional study was conducted based on the data extracted from the hospital information system (HIS) of one general hospital, which had the capability of performing PPCI 24 h a day, 7 days a week. All patients with STEMI who undergone PPCI during 1 year, transferred by emergency medical service (EMS) and their data were registered in the HIS were eligible. Besides the baseline characteristics, first medical contact (FMC)-to-balloon time was recorded. Morbidity based on predischarge left ventricular ejection fraction (LVEF) and mortality based on Global Registry of Acute Cardiac Events (GRACE) score were also recorded. Patients who were referred to the hospital by EMS with prehospital ECG and telecardiology were compared with those without prehospital ECG.
Totally, 298 patients with STEMI were enrolled, of whom 183 patients (61.4%) had prehospital ECG (telecardiology), and 115 patients (38.6%) had not. The means of predischarge LVEF of the patients in the first and the second groups were 40.7 ± 10.4 and 40.6 ± 11.2, respectively ( = 0.946). The mean of the probability of 6-month mortality based on GRACE score in the first group was significantly less than that of the second group ( = 0.004). Analyses of multivariable ordinal logistic regression showed that 6-month mortality severity risk in the second group was 1.5 times more than the first group (95% confidence interval 0.8-2.6), although this difference was not statistically significant ( = 0.199).
It is likely that prehospital telecardiology, with shortening FMC to balloon time result in reducing probability 6-month mortality in STEMI patients who undergone PPCI. However, the process of telecardiology had no effect on predischarge LVEF in the current study.
急性心肌梗死患者尽早进行直接经皮冠状动脉介入治疗（PPCI），预后越好。目的是评估基于心电图（ECG）和远程心脏病学的院前分诊对接受PPCI的ST段抬高型心肌梗死（STEMI）患者死亡率和发病率的影响。
本横断面研究基于从一家综合医院的医院信息系统（HIS）中提取的数据进行，该医院具备每周7天、每天24小时进行PPCI的能力。所有在1年内接受PPCI、由紧急医疗服务（EMS）转运且其数据已在HIS中登记的STEMI患者均符合条件。除了记录基线特征外，还记录了首次医疗接触（FMC）至球囊扩张时间。还记录了出院前基于左心室射血分数（LVEF）的发病率和基于全球急性心脏事件注册（GRACE）评分的死亡率。将通过EMS进行院前ECG和远程心脏病学转诊至医院的患者与未进行院前ECG的患者进行比较。
共纳入298例STEMI患者，其中183例（61.4%）有院前ECG（远程心脏病学），115例（38.6%）没有。第一组和第二组患者出院前LVEF的平均值分别为40.7±10.4和40.6±11.2（P=0.946）。第一组基于GRACE评分的6个月死亡率概率平均值显著低于第二组（P=0.004）。多变量有序逻辑回归分析显示，第二组的6个月死亡严重风险是第一组的1.5倍（95%置信区间0.8-2.6），尽管这种差异无统计学意义（P=0.199）。
院前远程心脏病学可能通过缩短FMC至球囊时间降低接受PPCI的STEMI患者6个月死亡率。然而，在本研究中，远程心脏病学过程对出院前LVEF没有影响。
