Mantovani Francesca, Guiducci Vincenzo, Colaiori Iginio, Pignatelli Gianluca, Manca Francesco, Guerri Elisa, Calzolari Massimo, Catellani Elisabetta, Reverzani Azio, Navazio Alessandro
Azienda Unità Sanitaria Locale, IRCCS di Reggio Emilia.
G Ital Cardiol (Rome). 2020 Oct;21(10):807-815. doi: 10.1714/3431.34207.
The service strategy (same-day transfer between the spoke hospital and the hub center with catheterization laboratory facility to perform invasive procedures) has been shown to improve the management of patients with non-ST-elevation acute coronary syndrome admitted to spoke hospitals. However, few data exist about the safety of this strategy and, in particular, the safety of retransferring patients to spoke centers immediately after successful percutaneous coronary intervention.
We used data from a prospective registry to retrospectively describe the application, performance and outcome of the service strategy in the daily clinical practice in our province, organized in 5 spoke hospitals and a hub center in Reggio Emilia, Italy.
From January 2013 to December 2017, 1183 consecutive patients were admitted to the cath-lab in the hub center from spoke hospitals with a diagnosis of non-ST-elevation acute coronary syndrome. Mean age was 68 ± 12 years, with a mean GRACE risk score of 137 ± 3. Overall, 1063 patients (90%) were managed with a service strategy. The mean time between hospital admission and access to the cath-lab for coronary artery angiography ± percutaneous coronary intervention was 46.6 h (27.5-71.2). No major adverse events (all-cause mortality, arrhythmias, or acute myocardial infarction) were observed during the back transfer from the invasive center to the referring non-invasive center. At 30 days, acute myocardial infarction was observed in 1.3% of patients and all-cause mortality was 0.5%. At 1-year follow-up, acute myocardial infarction was reported in 10% of patients and all-cause mortality was 2.8%.
A wide adoption of the service strategy in our provincial network in patients with non-ST-elevation acute coronary syndrome admitted to spoke centers allowed an early access to the cath-lab as recommended by international guidelines. The safety of the service strategy is confirmed in our experience, with no major adverse events occurring during the back transfer.
服务策略（在拥有导管实验室设施以进行侵入性操作的分支医院和中心医院之间进行当日转运）已被证明可改善入住分支医院的非ST段抬高型急性冠状动脉综合征患者的管理。然而，关于该策略安全性的数据很少，尤其是在成功进行经皮冠状动脉介入治疗后立即将患者转回分支中心的安全性。
我们使用了前瞻性注册研究的数据，对意大利雷焦艾米利亚的5家分支医院和1家中心医院在日常临床实践中该服务策略的应用、实施情况和结果进行回顾性描述。
2013年1月至2017年12月，1183例连续诊断为非ST段抬高型急性冠状动脉综合征的患者从分支医院被收治到中心医院的导管实验室。平均年龄为68±12岁，平均GRACE风险评分为137±3。总体而言，1063例患者（90%）采用了服务策略。从入院到进行冠状动脉造影±经皮冠状动脉介入治疗进入导管实验室的平均时间为46.6小时（27.5 - 71.2小时）。在从侵入性中心转回转诊的非侵入性中心的过程中，未观察到重大不良事件（全因死亡率、心律失常或急性心肌梗死）。在30天时，1.3%的患者发生急性心肌梗死，全因死亡率为0.5%。在1年随访时，10%的患者报告发生急性心肌梗死，全因死亡率为2.8%。
在我们省级网络中，广泛采用该服务策略使入住分支中心的非ST段抬高型急性冠状动脉综合征患者能够按照国际指南的建议尽早进入导管实验室。我们的经验证实了该服务策略的安全性，在转回过程中未发生重大不良事件。
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