Dep. of Radiation Sciences, Virginia Commonwealth University, Box 843057, Richmond, VA 23284-3057, USA. Tel 804-229-4347, fax 804-828-9104.
J Allied Health. 2021 Winter;50(4):292-298.
To determine process factors impacting myocardial infarction reperfusion time.
An ST-segment elevation myocardial infarction (STEMI) is a life-threatening condition that necessitates emergent medical treatment; longer reperfusion times are associated with negative patient outcomes. Therefore, time is critical in the treatment of a STEMI.
Admissions data from Las Vegas hospitals were analyzed via multivariate regression analysis to determine predictors of reperfusion times. The analysis was based on 618 patients presenting with a diagnosis of STEMI at participating facilities from 1 January 2015 to 31 December 2017. The dependent variable was door to balloon time; independent variables included the mode of arrival, regular vs off hours, pre-hospital electrocardiogram (ECG), the use of pre-hospital activation of the STEMI protocol, door to triage time, door to ECG time, door to first physician contact time, cardiologist arrival time, cardiac catheterization lab team arrival time, lifesaving measures prior to percutaneous coronary intervention (PCI), critical diagnostic exams prior to PCI, and anatomical variances causing PCI delay.
Prehospital STEMI activation, cardiologist arrival time, lifesaving measures, door to ECG time, time/day, critical diagnostics exams, and door to first MD time all had a statistically significant impact on door-to-balloon time (p < 0.05).
Timely identification of STEMI patients via ECG and activation of the STEMI protocol is paramount to shorten time to heart vessel reperfusion. However, this study indicates that some process factors indicated previously to impact reperfusion times did not have significantly effects in this study sample.
确定影响心肌梗死再灌注时间的过程因素。
ST 段抬高型心肌梗死（STEMI）是一种危及生命的病症，需要紧急医疗治疗；再灌注时间延长与患者预后不良相关。因此，时间在 STEMI 的治疗中至关重要。
通过多变量回归分析对拉斯维加斯医院的入院数据进行分析，以确定再灌注时间的预测因素。该分析基于 2015 年 1 月 1 日至 2017 年 12 月 31 日期间在参与机构就诊的 618 例 STEMI 诊断患者。因变量为门球时间；自变量包括到达方式、常规时间与非工作时间、院前心电图（ECG）、院前 STEMI 方案激活的使用、分诊至门时间、门至 ECG 时间、门至首诊医生时间、心脏病专家到达时间、心脏导管实验室团队到达时间、经皮冠状动脉介入治疗（PCI）前的救生措施、PCI 前的关键诊断检查，以及导致 PCI 延迟的解剖差异。
院前 STEMI 激活、心脏病专家到达时间、救生措施、门至 ECG 时间、时间/天、关键诊断检查和首诊 MD 时间均对门球时间有统计学显著影响（p < 0.05）。
通过 ECG 及时识别 STEMI 患者并激活 STEMI 方案对于缩短血管再灌注时间至关重要。然而，本研究表明，一些先前表明会影响再灌注时间的过程因素在本研究样本中没有产生显著影响。
