Prehosp Emerg Care. 2021 Jul-Aug;25(4):487-495. doi: 10.1080/10903127.2020.1809753. Epub 2020 Oct 5.
Field identification and treatment of ST-segment elevation myocardial infarction (STEMI) by paramedics is an important component of care for these patients. There is a paucity of studies in the setting of paramedic-identified STEMI. This study investigated mortality and factors associated with mortality in a large state-wide prehospital STEMI sample. Included were adult STEMI patients identified and treated with reperfusion therapy by paramedics in the field between January 2016 and December 2018 in Queensland, Australia. 30-day and one-year all-cause mortality was compared between two prehospital reperfusion pathways: prehospital fibrinolysis versus direct referral to a hospital for primary percutaneous coronary intervention (direct percutaneous coronary intervention [PCI] referral). For prehospital fibrinolysis patients, factors associated with failed fibrinolysis were investigated. For direct PCI referral patients, factors associated with mortality were examined. The 30-day mortality was 2.2% for prehospital fibrinolysis group and 1.8% for direct PCI referral group ( = 0.661). One-year mortality for the two groups was 2.7% and 3.2%, respectively ( = 0.732). Failed prehospital fibrinolysis was observed in 20.1% of patients receiving this therapy, with male gender and history of heart failure being predictors. For direct PCI referral group, low left ventricular ejection fraction (LVEF) on admission and cardiogenic shock prior to PCI were predictors of both 30-day and one-year mortality. Aboriginal and Torres Strait Islander status, and impaired kidney function on admission, were associated with one-year but not 30-day mortality. Being overweight was associated with lower 30-day mortality. Mortality in STEMI patients identified and treated by paramedics was low, and the prehospital fibrinolysis treatment pathway was effective with a mortality rate comparable to that of patients undergoing primary PCI. prehospital; Queensland; cardiac reperfusion; STEMI.
急救人员现场识别和治疗 ST 段抬高型心肌梗死（STEMI）是此类患者治疗的重要组成部分。在急救人员识别的 STEMI 情况下，研究相对较少。本研究调查了澳大利亚昆士兰州在现场通过急救人员识别和接受再灌注治疗的大型全州范围内 STEMI 样本的死亡率和与死亡率相关的因素。研究纳入了 2016 年 1 月至 2018 年 12 月期间在现场通过急救人员识别并接受溶栓治疗的成年 STEMI 患者。比较了两种院前再灌注途径（院前溶栓与直接转院行直接经皮冠状动脉介入治疗（直接 PCI 转诊））的 30 天和 1 年全因死亡率。对于接受院前溶栓的患者，调查了溶栓失败的相关因素。对于直接 PCI 转诊的患者，检查了与死亡率相关的因素。院前溶栓组的 30 天死亡率为 2.2%，直接 PCI 转诊组为 1.8%（ = 0.661）。两组 1 年死亡率分别为 2.7%和 3.2%（ = 0.732）。接受该治疗的患者中有 20.1%观察到院前溶栓失败，男性和心力衰竭史是预测因素。对于直接 PCI 转诊组，入院时左心室射血分数（LVEF）低和 PCI 前心源性休克是 30 天和 1 年死亡率的预测因素。入院时存在澳大拉西亚裔和托雷斯海峡岛民身份以及肾功能受损与 1 年死亡率相关，但与 30 天死亡率无关。超重与较低的 30 天死亡率相关。通过急救人员识别和治疗的 STEMI 患者死亡率较低，院前溶栓治疗途径有效，死亡率与接受直接 PCI 的患者相当。院前；昆士兰州；心脏再灌注；STEMI。
