Balghith Mohammed Ali
King Abdulaziz Cardiac Center, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Heart Views. 2020 Oct-Dec;21(4):251-255. doi: 10.4103/HEARTVIEWS.HEARTVIEWS_70_20. Epub 2021 Jan 14.
The reperfusion therapy using primary percutaneous coronary intervention (PPCI) in ST-segment elevation myocardial infarction (STEMI) is known to give a better result than fibrinolytic therapy. The fast access to PPCI will improve hospital outcome. We believe that patient access to PPCI facility would have improved due to enhanced public awareness and expanding evidenced-based health provision.
This is a single-center retrospective study to analyze and compare data for STEMI patients. Patients were transferred to our hospital during the year 2010. Group l comprised 223 patients. Group 2 comprised 288 patients. Group 2 patients were those treated between August 2014 and August 2015. We compared their demographic and baseline characteristics, patients' access to the hospital, reasons for no access, and hospital mortality for the two groups.
Among the 288 patients in Group 2, 247 patients (85%) were males with an average age of 57 years, 49% were diabetics, 48% were hypertensive, 48% were smokers, and 27% were obese. These were not different in Group 1. In Group 2, 164 patients (57%) only had access to PPCI compared to 56% in Group 1 ( = 0.536-NS). In G2, the main reasons for no PPCI were late presentation in 47% versus 53% in Group 1; = 0.34 NS. In Group 2, 27% were due to thrombolysis versus 17% in Group 1 ( = 0.11 NS). Hospital mortality in Group 2 was 4% in those treated with PPCI compared to 2.3% in Group 1 ( = 0.522-NS). Mortality in patients who did not receive PPCI in Group 2 was 8% compared to 11.3% in Group 1 ( = 0.49-NS). Females in Group 2 have about 3 times higher mortality. Patients treated for STEMI in the last 12 months at King Abdulaziz Cardiac Center still have relatively low access to PPCI due mainly to persistent pattern of late presentation and prior thrombolysis, which reflect apparent lack of direct access to hospitals with PPCI facilities.
Comparing the two periods, there was no change in cardiology practice. The low access to PPCI was mainly due to late presentation and prior thrombolysis. Hospital mortality rate for patients treated with PPCI remained low during the two era. This seemingly relates to both lack of public awareness and health provision factors in PPCI organizations.
在ST段抬高型心肌梗死（STEMI）中，使用直接经皮冠状动脉介入治疗（PPCI）的再灌注疗法已知比纤维蛋白溶解疗法效果更好。快速获得PPCI将改善医院治疗结果。我们认为，由于公众意识增强和循证医疗服务的扩大，患者获得PPCI设施的情况会有所改善。
这是一项单中心回顾性研究，旨在分析和比较STEMI患者的数据。患者于2010年被转至我院。第1组包括223例患者。第2组包括288例患者。第2组患者为2014年8月至2015年8月期间接受治疗的患者。我们比较了两组患者的人口统计学和基线特征、患者到院就诊情况、未就诊原因以及医院死亡率。
在第2组的288例患者中，247例（85%）为男性，平均年龄57岁，49%为糖尿病患者，48%为高血压患者，48%为吸烟者，27%为肥胖者。这些情况在第1组中无差异。在第2组中，164例患者（57%）能够接受PPCI，而第1组为56%（P = 0.536，无统计学意义）。在第2组中，未接受PPCI的主要原因是就诊延迟的占47%，第1组为53%（P = 0.34，无统计学意义）。在第2组中，27%是由于接受了溶栓治疗，第1组为17%（P = 0.11，无统计学意义）。第2组中接受PPCI治疗的患者医院死亡率为4%，第1组为2.3%（P = 0.522，无统计学意义）。第2组中未接受PPCI治疗的患者死亡率为8%，第1组为11.3%（P = 0.49，无统计学意义）。第2组中的女性死亡率约高出3倍。在阿卜杜勒阿齐兹国王心脏中心过去12个月内接受STEMI治疗的患者获得PPCI的机会仍然相对较低，主要原因是持续存在就诊延迟模式和既往接受过溶栓治疗，这反映出明显缺乏直接前往具备PPCI设施医院就诊的途径。
比较两个时期，心脏病学实践没有变化。PPCI可及性低主要是由于就诊延迟和既往接受过溶栓治疗。在两个时期，接受PPCI治疗的患者医院死亡率仍然较低。这似乎与公众意识缺乏以及PPCI机构的医疗服务因素都有关。
