Department of Paramedicine, Monash University, Frankston, Victoria, Australia.
Department of Allied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan.
Open Heart. 2021 May;8(1). doi: 10.1136/openhrt-2021-001654.
To explore the relationship between emergency medical service (EMS) delay time, overall time to reperfusion and clinical outcome in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI).
This was a retrospective observational study of 2976 patients with STEMI who presented to EMS and underwent PPCI between January 2014 and December 2017. We performed multivariable logistic models to assess the relationship between EMS delay time and 30-day mortality and to identify factors associated with system delay time.
EMS delay time accounted for the first half of total system delay (median=59 min (IQR=48-77)). Compared with those who survived, those who died had longer median EMS delay times (59 (IQR=11-74) vs 74 (IQR=57-98), p<0.001). EMS delay time was independently associated with a higher risk of mortality (adjusted OR 1.20; 95% CI 1.02 to 1.40, for every 30 min increase), largely driven by complicated patients with cardiogenic shock or cardiac arrest. Independent predictors of longer EMS delay times were older age, women, cardiogenic shock, cardiac arrest, prehospital notification and intensive care management. Although longer EMS delay times were associated with shorter door-to-balloon times, total system delay times increased with increasing EMS delay times.
Increasing EMS delay times, particularly those result from haemodynamic complications, increase total time to reperfusion and are associated with 30-day mortality after STEMI. All efforts should be made to monitor and reduce EMS delay times for timely reperfusion and better outcome.
探讨在接受直接经皮冠状动脉介入治疗（PPCI）的 ST 段抬高型心肌梗死（STEMI）患者中，急救医疗服务（EMS）延迟时间、总再灌注时间与临床结局的关系。
这是一项回顾性观察研究，纳入了 2014 年 1 月至 2017 年 12 月期间因 STEMI 就诊于 EMS 并接受 PPCI 的 2976 例患者。我们采用多变量逻辑模型评估 EMS 延迟时间与 30 天死亡率之间的关系，并确定与系统延迟时间相关的因素。
EMS 延迟时间占总系统延迟时间的前半部分（中位数=59 分钟（IQR=48-77））。与存活患者相比，死亡患者的 EMS 延迟时间中位数更长（59（IQR=11-74）与 74（IQR=57-98），p<0.001）。EMS 延迟时间与更高的死亡率风险独立相关（调整后的 OR 1.20；95%CI 1.02 至 1.40，每增加 30 分钟），这主要是由伴有心源性休克或心脏骤停的复杂患者驱动的。EMS 延迟时间较长的独立预测因素包括年龄较大、女性、心源性休克、心脏骤停、院前通知和重症监护管理。尽管 EMS 延迟时间较长与门球时间较短相关，但随着 EMS 延迟时间的增加，总系统延迟时间也会增加。
EMS 延迟时间的增加，特别是由血流动力学并发症引起的延迟时间的增加，会延长总再灌注时间，并与 STEMI 后 30 天的死亡率相关。应尽一切努力监测和减少 EMS 延迟时间，以实现及时再灌注和更好的结局。
