From the Department of Emergency Medicine, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
From the Department of Cardiovascular Diseases, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.
Ann Saudi Med. 2020 Jul-Aug;40(4):281-289. doi: 10.5144/0256-4947.2020.281. Epub 2020 Aug 6.
Atherosclerotic heart disease is still a leading cause of mortality despite improvements in cardiovascular care. Percutaneous coronary intervention (PCI) is the recommended reperfusion therapy in acute ST-elevation myocardial infarction (STEMI), and the international guideline is to achieve a door-to-balloon (D2B) time within 90 minutes of patient arrival to an emergency department (ED).
Describe interventions, data for the study period, challenges in ensuring 24/7 patient access to PCI and quality indicators.
Retrospective observational study.
Tertiary care institution in Riyadh, Saudi Arabia.
We included all acute coronary syndrome patients from 2010-2018 who presented or were transferred to our ED from nearby non-PCI capable hospitals, and for whom a 'code heart' was activated. Electronic medical records and the patient care report from the ambulance services were accessed for data collection.
D2B time, readmission and mortality rate.
354 patients, mean age (standard deviation) 55.6 (12.6) years, males 84.5% (n=299).
STEMI patients constituted 94% (n=334) of the study group; the others had non-STEMI or unstable angina. Hypertension (51%) was the most prevalent risk factor. Coronary artery stenting was the most frequent intervention (77.4%) followed by medical therapy (14.7%). The most common culprit artery was the left anterior descending (52.5%) followed by the right coronary artery (26.0%). A D2B time of within 90 minutes was achieved in over 85% of the patients in four of the years in the 278 patients who underwent PCI. The median D2B time (interquar-tile range) over 2010-2018 was 79 (31) minutes.
Meeting the international benchmark of D2B time within 90 minutes for STEMI patients is achievable when the main stakeholders collaborate in patient-centric care. Our patient demographics represent regional trends.
Patient acceptance to our institution is based upon eligibility criteria. Transfer of 'code heart' patients from other institutions was carried out by our ambulance team. The credentials and experience of cardiologists, emergency physicians, and ambulance services are not standardized across the country. Therefore, the results may not be generalizable to other institutions.
None.
尽管心血管治疗取得了进步，但动脉粥样硬化性心脏病仍然是导致死亡的主要原因。经皮冠状动脉介入治疗（PCI）是急性 ST 段抬高型心肌梗死（STEMI）的推荐再灌注治疗，国际指南要求患者到达急诊科（ED）的门到球囊（D2B）时间在 90 分钟内。
描述干预措施、研究期间的数据、确保患者 24/7 获得 PCI 治疗机会的挑战以及质量指标。
回顾性观察性研究。
沙特利雅得的三级医疗机构。
我们纳入了所有 2010-2018 年从附近无 PCI 能力的医院转至我院 ED 的急性冠状动脉综合征患者，这些患者的“心脏代码”被激活。我们查阅了电子病历和救护车服务的患者护理报告以获取数据。
D2B 时间、再入院率和死亡率。
354 例患者，平均年龄（标准差）为 55.6（12.6）岁，男性占 84.5%（n=299）。
STEMI 患者占研究组的 94%（n=334）；其余患者患有非 STEMI 或不稳定型心绞痛。高血压（51%）是最常见的危险因素。冠状动脉支架置入术是最常见的干预措施（77.4%），其次是药物治疗（14.7%）。最常见的罪犯血管是左前降支（52.5%），其次是右冠状动脉（26.0%）。在接受 PCI 的 278 例患者中，有 4 年超过 85%的患者实现了 D2B 时间在 90 分钟内的国际基准。2010-2018 年期间的中位数 D2B 时间（四分位间距）为 79（31）分钟。
当主要利益相关者在以患者为中心的护理方面进行合作时，STEMI 患者达到国际 D2B 时间 90 分钟的基准是可行的。我们的患者人口统计学特征代表了区域趋势。
患者接受我院治疗是基于入选标准。其他机构的“心脏代码”患者的转移由我院的救护车团队完成。该国各地的心脏病专家、急诊医生和救护车服务的资质和经验并未标准化。因此，结果可能不适用于其他机构。
无。
