Cui C Y, Zhou M G, Chen A F, Cheng L C, Zhang C, Liu H X, Cai L
Department of Cardiology, Third People's Hospital of Chengdu Affiliated to Southwest Jiaotong University, Chengdu 610031, China.
Department of Cardiology, First People's Hospital of Shuangliu District, Chengdu, Chengdu 610200, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2020 Apr 24;48(4):302-307. doi: 10.3760/cma.j.cn112148-20190815-00494.
To analyze the impact of different admission ways on the timeliness of percutaneous coronary intervention and in-hospital mortality in patients with acute ST-segment elevation myocardial infarction (STEMI). A total of 1 044 patients with STEMI, who received primary percutaneous coronary intervention (PPCI) in 9 hospitals in Chengdu from January 2017 to June 2019, were retrospectively enrolled. According to the admission ways, patients were divided into ambulance group (100), self-transport group (584) and transferred group (360). Timeliness and in-hospital mortality were compared among the groups. Indicators of timeliness included the time from symptoms onset to arrive at the hospital, the time from arrive at the hospital to balloon and the total myocardial ischemia time (the time from symptoms to balloon). Multivariate logistic regression analysis was used to verify whether the admission ways was the determinant for in-hospital death in STEMI patients receiving PPCI. The median total myocardial ischemic time in the ambulance group was significantly shorter than that in the self-transport group (180.0 (135.0, 282.0) minutes vs. 278.0 (177.8, 478.5) minutes, 0.05) and the transferred group (180.0 (135.0, 282.0) minutes vs. 301.0 (204.3, 520.8) minutes, 0.05). The median time from symptoms to door was as follows: ambulance group<self-transport group<transferred group (100.0 (56.3, 198.0) minutes vs. 149.0 (72.0, 313.5) minutes vs. 238.0 (135.0, 545.0) minutes, all 0.05). The median door-to-balloon time was significantly shorter in the ambulance group and transferred group than in the self-transport group (75.0 (44.3, 101.8) minutes vs. 97.0 (71.0, 140.5) minutes, 67.0 (40.0, 91.8) minutes vs. 97.0 (71.0, 140.5) minutes, both 0.05). There was no significant difference in all-cause mortality among the three groups (0.05). Multivariate logistic regression analysis showed that admission way was not significantly associated with in-hospital death (0.05). STEMI patients, who are admitted through the medical emergency system, are more likely to receive timely interventional therapy.Different admission ways have no impact on in-hospital mortality.
分析不同入院方式对急性ST段抬高型心肌梗死（STEMI）患者经皮冠状动脉介入治疗及时性及院内死亡率的影响。回顾性纳入2017年1月至2019年6月在成都9家医院接受直接经皮冠状动脉介入治疗（PPCI）的1044例STEMI患者。根据入院方式，将患者分为救护车组（100例）、自行转运组（584例）和转院组（360例）。比较各组间的及时性和院内死亡率。及时性指标包括症状发作至入院时间、入院至球囊扩张时间及总心肌缺血时间（症状至球囊扩张时间）。采用多因素logistic回归分析验证入院方式是否为接受PPCI的STEMI患者院内死亡的决定因素。救护车组的总心肌缺血时间中位数显著短于自行转运组（180.0（135.0，282.0）分钟对278.0（177.8，478.5）分钟，<0.05）和转院组（180.0（135.0，282.0）分钟对301.0（204.3，520.8）分钟，<0.05）。症状至入院时间中位数如下：救护车组<自行转运组<转院组（100.0（56.3，198.0）分钟对149.0（72.0，313.5）分钟对238.0（135.0，545.0）分钟，均<0.05）。救护车组和转院组的入院至球囊扩张时间中位数显著短于自行转运组（75.0（44.3，101.8）分钟对97.0（71.0，140.5）分钟，67.0（40.0，91.8）分钟对97.0（71.0，140.5）分钟，均<0.05）。三组间全因死亡率无显著差异（P>0.05）。多因素logistic回归分析显示入院方式与院内死亡无显著相关性（P>0.05）。通过医疗急救系统入院的STEMI患者更易接受及时的介入治疗。不同入院方式对院内死亡率无影响。
