From the Interventional Cardiology, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
Department of Cardiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Crit Pathw Cardiol. 2021 Jun 1;20(2):81-87. doi: 10.1097/HPC.0000000000000244.
Due to the importance of early treatment in the final prognosis of ST-elevation myocardial infarction (STEMI) patients, full-time provision of revascularization services should be available 24 hours a day, 7 days a week (24/7) in conjunction with a fully-coordinated pre-hospital emergency system and equipped centers with experienced medical teams. We reviewed the 24/7 primary percutaneous coronary intervention (PCI) management registry and evaluated the quality of care and patient management as well as the temporal trend of provided health care services. In the present cross-sectional study, we retrieved the data on 11,563 STEMI patients having undergone primary PCI at the thirty-one 24/7 PCI-capable hospitals through the national 24/7 STEMI management program between September 2015 and August 2017 in Iran. The median (25th-75th) age of the patients was 59 (51-68) years. The median (25th-75th) time of door-to-device was 64 (41-100) min and 68% of patients achieved door to device time of ≤90 min. There was no significant difference in the median door-to-device time between the general and heart hospitals. This is the first Iranian National attempt to provide a uniform guideline-driven standard management in patients with STEMI undergoing primary PCI in a 24/7 program. We demonstrated an acceptable door-to-device time consistent with the recommendations of the current guidelines. We observed higher door-to-device time in older patients, female patients, and those where the culprit lesion was other than the left anterior descending coronary artery. Efforts should be made to improve door-to-device time in all patients or groups.
由于在 ST 段抬高型心肌梗死（STEMI）患者的最终预后中早期治疗至关重要，因此应 24 小时/天、7 天/周（24/7）提供全时血运重建服务，同时结合完善的院前急救系统和配备有经验医疗团队的中心。我们回顾了 24/7 直接经皮冠状动脉介入治疗（PCI）管理登记处，并评估了护理质量和患者管理，以及提供医疗服务的时间趋势。在本横断面研究中，我们通过国家 24/7 STEMI 管理计划，从 2015 年 9 月至 2017 年 8 月，从 31 家 24/7 能够进行直接 PCI 的医院中检索了 11563 名接受直接 PCI 的 STEMI 患者的数据。患者的中位数（25-75）年龄为 59（51-68）岁。中位数（25-75）门到球囊时间为 64（41-100）分钟，68%的患者达到门到球囊时间≤90 分钟。普通医院和心脏医院的中位数门到球囊时间没有显著差异。这是伊朗国家首次尝试在 24/7 计划中为接受直接 PCI 的 STEMI 患者提供一致的、以指南为导向的标准管理。我们展示了与当前指南建议一致的可接受的门到球囊时间。我们观察到年龄较大的患者、女性患者和罪犯病变不是左前降支的患者的门到球囊时间较长。应努力改善所有患者或群体的门到球囊时间。
