Cardiology department. Hospital de São Teotónio. Centro Hospitalar Tondela-Viseu. Viseu. Portugal.
Cardiology department. Hospital de São Teotónio. Centro Hospitalar Tondela-Viseu. Viseu.
Acta Med Port. 2020 Jun 1;33(6):390-400. doi: 10.20344/amp.11082. Epub 2020 May 31.
Emergency medical system transportation has been shown to reduce treatment times in ST-segment elevation myocardial infarction. The authors studied the Portuguese National Registry of Acute Coronary Syndromes to determine the nationwide impact of the emergency medical system transportation in the treatment of ST-segment elevation myocardial infarction.
A multicentric, nationwide, retrospective study of ST-segment elevation myocardial infarction patients inserted in the National Registry from 2010 to 2017 was performed. The patients were divided into: Group I, composed of patients transported by emergency medical system, and Group II, patients arriving to the Emergency department by other means.
Of the 5702 patients studied, 25.9% were transported via emergency medical system. Rates of emergency medical system activation increased by 17% in the last 7 years. The emergency medical system provided a higher rate of transport to a percutaneous coronary intervention capable centre, of Emergency department bypass, of on-site fibrinolysis, and ensured a 59-minute reduction of the median reperfusion time (p < 0.001). There was no difference in in-hospital mortality.
In this nationwide cohort, emergency medical system transportation is associated with a reduction in reperfusion times. It provides a higher amount of salvaged myocardium and reduces the incidence of acute heart failure. However, emergency medical system use did not result in lower in-hospital mortality, probably due to confounding factors of higher disease severity and comorbidity.
The benefits associated with emergency medical system based transportation of patients with ST-segment elevation myocardial infarction do not translate into lower in-hospital mortality.
急诊医疗系统的转运已被证明可以缩短 ST 段抬高型心肌梗死的治疗时间。作者研究了葡萄牙国家急性冠状动脉综合征注册中心，以确定全国范围内急诊医疗系统转运在 ST 段抬高型心肌梗死治疗中的影响。
这是一项多中心、全国性的回顾性研究，纳入了 2010 年至 2017 年国家注册中心的 ST 段抬高型心肌梗死患者。患者分为两组：I 组，由急诊医疗系统转运的患者组成；II 组，由其他方式到达急诊部的患者组成。
在 5702 名研究患者中，25.9%通过急诊医疗系统转运。在过去的 7 年中，急诊医疗系统的激活率增加了 17%。急诊医疗系统提供了更高的转运至可进行经皮冠状动脉介入治疗的中心、急诊部绕过、现场溶栓的机会，并确保再灌注时间中位数缩短了 59 分钟（p<0.001）。院内死亡率无差异。
在这项全国性队列研究中，急诊医疗系统的转运与再灌注时间的缩短有关。它提供了更多可挽救的心肌，并降低了急性心力衰竭的发生率。然而，急诊医疗系统的使用并没有导致更低的院内死亡率，这可能是由于疾病严重程度和合并症等混杂因素的影响。
与 ST 段抬高型心肌梗死患者基于急诊医疗系统的转运相关的益处并未转化为更低的院内死亡率。
