Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Tübingen, Tübingen, Germany.
Med Klin Intensivmed Notfmed. 2021 Nov;116(8):694-697. doi: 10.1007/s00063-020-00739-3. Epub 2020 Oct 8.
In case of suspected acute coronary syndrome (ACS), international guidelines recommend to obtain a 12-lead ECG as soon as possible after first medical contact, to administrate platelet aggregation inhibitors and antithrombins, and to transfer the patient as quickly as possible to an emergency department.
A German emergency care service database was retrospectively analysed from 2014 to 2016. Data were tested for normal distribution and the Mann-Whitney test was used for statistical analysis. Results are presented as medians (IQR).
A total of 1424 patients with suspected ACS were included in the present analysis. A 12-lead ECG was documented in 96% of patients (n = 1369). The prehospital incidence of ST-segment elevation myocardial infarction (STEMI) was 18% (n = 250). In 981 patients (69%), acetylsalicylic acid (ASA), unfractionated heparin (UFH), or ASA and UFH was given. Time in prehospital care differed significantly between non-STEMI (NSTEMI) ACS (37 [IQR 30, 44] min) and STEMI patients (33 [IQR 26, 40] min, n = 1395, p < 0.0001). Most of NSTEMI ACS and STEMI patients were brought to the emergency care unit, while 30% of STEMI patients were directly handed over to a cardiac catheterization laboratory.
Prehospital ECG helps to identify patients with STEMI, which occurs in 18% of suspected ACS. Patients without ST-elevations suffered from longer prehospital care times. Thus, it is tempting to speculate that ST-elevations in patients prompt prehospital medical teams to act more efficiently while the absence of ST-elevations even in patients with suspected ACS might cause unintended delays. Moreover, this analysis suggests the need for further efforts to make the cardiac catheterization laboratory the standard hand-over location for all STEMI patients.
在疑似急性冠状动脉综合征（ACS）的情况下，国际指南建议在首次医疗接触后尽快获得 12 导联心电图，给予血小板聚集抑制剂和抗血栓药物，并尽快将患者转至急诊科。
回顾性分析了 2014 年至 2016 年德国急救服务数据库。对数据进行正态分布检验，采用 Mann-Whitney 检验进行统计学分析。结果以中位数（IQR）表示。
本研究共纳入 1424 例疑似 ACS 患者。96%（n=1369）的患者记录了 12 导联心电图。院前 ST 段抬高型心肌梗死（STEMI）发生率为 18%（n=250）。在 981 例患者（69%）中给予了乙酰水杨酸（ASA）、未分级肝素（UFH）或 ASA 和 UFH。非 ST 段抬高型心肌梗死（NSTEMI）ACS（37[IQR 30，44]min）和 STEMI 患者（33[IQR 26，40]min，n=1395，p<0.0001）的院前护理时间差异有统计学意义。大多数 NSTEMI ACS 和 STEMI 患者被送往急救护理单位，而 30%的 STEMI 患者直接转至心脏导管实验室。
院前心电图有助于识别 STEMI 患者，在疑似 ACS 患者中占 18%。没有 ST 段抬高的患者院前护理时间较长。因此，人们不禁推测，STEMI 患者的 ST 段抬高促使院前医疗团队更有效地行动，而疑似 ACS 患者即使没有 ST 段抬高也可能导致不必要的延误。此外，本分析表明需要进一步努力，使心脏导管实验室成为所有 STEMI 患者的标准交接地点。
