Jung Man Soo, Kim Yong Won, Lee Sanghun, Seo Jun Seok, Lee Jeong Hun, Lee Seung Chul, Do Han Ho
Department of Emergency Medicine, Dongguk University Ilsan Hospital, Dongguk University College of Medicine, Goyang, Korea.
Clin Exp Emerg Med. 2020 Jun;7(2):114-121. doi: 10.15441/ceem.19.077. Epub 2020 Jun 30.
Prompt reperfusion is important for patients with ST elevation myocardial infarction (STEMI). However, patients often require interhospital transfer for percutaneous coronary intervention (PCI) because not all hospitals can provide. The purpose of this study is to reduce the PCI delay using a regionalization protocol in patients with STEMI following transfer from another hospital lacking PCI facility.
We established a revascularization protocol designated as Preparing Revascularization Effort before Patients' Arrival via Regionalization Engagement (PREPARE) for the STEMI patients transferred from an outside regional hospital. The protocol included immediate referral acceptance by an emergency physician, real-time electrocardiogram sharing via mobile phone and early activation of the PCI team. We analyzed the differences between the PREPARE and the non-PREPARE groups.
In the PREPARE group, the median time from the first hospital visit to the ballooning procedure via PCI at the receiving facility (D1-to-B time) was 111.0 (interquartile range 97.0-130.0) minutes, which was significantly shorter than in the non-PREPARE group 134.0 (interquartile range 115.0-182.0) minutes. The proportion of D1-to-B time within 120 minutes was 30.4% in the group and 60.0% in the PREPARE group, which represents a significant difference (P=0.004). Multivariate logistic regression analysis revealed that patient transfer via PREPARE protocol (odds ratio, 3.399; 95% confidence interval, 1.150-10.050, P=0.027) was related to adequate D1-to-B time. No statistically significant differences were found in the hospital length of stay or major adverse cardiac events within 4 weeks.
The PREPARE protocol is an effective strategy to reduce the time to revascularization of the transferred STEMI patients.
对于ST段抬高型心肌梗死（STEMI）患者而言，迅速再灌注至关重要。然而，由于并非所有医院都能提供经皮冠状动脉介入治疗（PCI），患者常常需要在不同医院间转运以接受该治疗。本研究的目的是通过一种区域化方案来减少缺乏PCI设备的医院转出的STEMI患者的PCI延迟。
我们为从外部区域医院转出的STEMI患者制定了一项血管再通方案，命名为“通过区域化协作在患者到达前准备血管再通工作（PREPARE）”。该方案包括急诊医生立即接受转诊、通过手机实时共享心电图以及提前启动PCI团队。我们分析了PREPARE组和非PREPARE组之间的差异。
在PREPARE组中，从首次就诊到在接收机构通过PCI进行球囊扩张手术的中位时间（D1至B时间）为111.0（四分位间距97.0 - 130.0）分钟，显著短于非PREPARE组的134.0（四分位间距115.0 - 182.0）分钟。D1至B时间在120分钟内的比例在非PREPARE组为30.4%，在PREPARE组为60.0%，差异有统计学意义（P = 0.004）。多因素逻辑回归分析显示，通过PREPARE方案进行患者转运（比值比，3.399；95%置信区间，1.150 - 10.050，P = 0.027）与充足的D1至B时间相关。在住院时间或4周内的主要不良心脏事件方面未发现统计学显著差异。
PREPARE方案是减少转出的STEMI患者血管再通时间的有效策略。
