Lee Simon, Miller Rory, Lee Mildred, White Harvey, Kerr Andrew
Basic Trainee, Department of General Medicine, Middlemore Hospital, Counties Manukau District Health Board, Auckland.
Senior Lecturer, Rural Section, Department of General Practice and Rural Health, University of Otago; Rural Doctor, Thames Hospital, Waikato District Health Board.
N Z Med J. 2020 Oct 30;133(1524):64-81.
Primary percutaneous coronary intervention (PCI) is the optimal reperfusion strategy to manage ST-elevation myocardial infarction (STEMI). Where timely primary PCI cannot be achieved, an initial pharmacological reperfusion strategy is recommended with subsequent transfer to a PCI-capable hospital. The study aim was to assess STEMI outcomes according to the interventional capability of the New Zealand hospital to which patients initially present.
Nine thousand four hundred and eighty-eight New Zealand patients, aged 20-79 years, admitted with STEMI to a public hospital were identified. Patients were categorised into three groups-metropolitan hospitals with all-hours access to primary PCI (routine primary PCI cohort), metropolitan hospitals without routine access to PCI, and rural hospitals. The primary outcome was all-cause mortality. Secondary outcomes were major adverse cardiac events (MACE) and major bleeding.
Invasive coronary angiography was more frequent in the routine primary PCI cohort compared to metropolitan hospitals without routine access to PCI and rural hospitals (90.6 vs 83.0 vs 85.0% respectively; p<0.001) and occurred more commonly on the day of admission (78.9 vs 28.7 vs 25.7% respectively; p<0.001). There were no differences in multivariable adjusted all-cause mortality, MACE or major bleeding between patients admitted to any of the hospital groupings.
Outcomes after STEMI in New Zealand are similar regardless of the interventional capability of the hospital where they first present.
直接经皮冠状动脉介入治疗（PCI）是治疗ST段抬高型心肌梗死（STEMI）的最佳再灌注策略。若无法及时进行直接PCI，则建议采用初始药物再灌注策略，随后转至具备PCI能力的医院。本研究旨在根据患者最初就诊的新西兰医院的介入治疗能力评估STEMI的治疗结果。
确定了9488名年龄在20 - 79岁之间、因STEMI入住公立医院的新西兰患者。患者被分为三组：可随时进行直接PCI的大城市医院（常规直接PCI队列）、无法常规进行PCI的大城市医院以及农村医院。主要结局是全因死亡率。次要结局是主要不良心脏事件（MACE）和大出血。
与无法常规进行PCI的大城市医院和农村医院相比，常规直接PCI队列中侵入性冠状动脉造影更为频繁（分别为90.6%、83.0%和85.0%；p<0.001），且更常在入院当天进行（分别为78.9%、28.7%和25.7%；p<0.001）。在任何一组医院入院的患者之间，多变量调整后的全因死亡率、MACE或大出血方面均无差异。
在新西兰，无论患者最初就诊医院的介入治疗能力如何，STEMI后的治疗结果相似。
