Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Emerg Med J. 2022 Sep;39(9):666-671. doi: 10.1136/emermed-2020-210522. Epub 2021 Dec 14.
Delay to reperfusion in ST-elevation myocardial infarction (STEMI) is detrimental, but can be minimised with prehospital notification by ambulance to the treating hospital. We aimed to assess whether prenotification was associated with improved first medical contact to balloon times (FMC-BT) and whether this resulted in better clinical outcomes. We also aimed to identify factors associated with use of prenotification.
This was a retrospective study of prospective Victorian Cardiac Outcomes Registry data for patients undergoing primary percutaneous coronary intervention for STEMI from 2013-2018. Postcardiac arrest were excluded. Patients were grouped by whether they arrived by ambulance with prenotification (group 1), arrived by ambulance without prenotification (group 2) or self-presented (group 3). We compared groups by FMC-BT, incidence of major adverse cardiac and cerebrovascular events (MACCE), mortality and factors associated with the use of prenotification.
2891 patients were in group 1 (79.3% male), 1620 in group 2 (75.7% male) and 1220 in group 3 (82.9% male). Patients who had prenotification were more likely to present in-hours (p=0.004) and self-presenters had lowest rates of cardiogenic shock (p<0.001). Prenotification had shorter FMC-BT than without prenotification (104 min vs 132 min, p<0.001) Self-presenters had superior clinical outcomes, with no difference between ambulance groups. Groups 1 and 2 had similar 30-day MACCE outcomes (7.4% group 1 vs 9.1% group 2, p=0.05) and similar mortality (4.6% group 1 vs 5.9% group 2, p=0.07). In multivariable analysis, male gender, right coronary artery culprit and in-hours presentation independently predicted use of prenotification (all p<0.05).
Differences in clinical characteristics, particularly gender, time of presentation and culprit vessel may influence ambulance prenotification. Ambulance cohorts have high-risk features and worse outcomes compared with self-presenters. Improving system inequality in prehospital STEMI diagnosis is recommended for fastest STEMI treatment.
ST 段抬高型心肌梗死（STEMI）再灌注时间延迟有害，但通过救护车向治疗医院进行院前通知可将其最小化。我们旨在评估预先通知是否与首次医疗接触球囊时间（FMC-BT）的改善相关，以及这是否导致更好的临床结局。我们还旨在确定与预先通知使用相关的因素。
这是一项对 2013 年至 2018 年接受经皮冠状动脉介入治疗的 STEMI 患者的前瞻性维多利亚心脏结局登记处数据进行的回顾性研究。排除心搏骤停后患者。患者分为通过救护车带预先通知到达（第 1 组）、通过救护车无预先通知到达（第 2 组）或自行就诊（第 3 组）。我们通过 FMC-BT、主要不良心脏和脑血管事件（MACCE）发生率、死亡率和与预先通知使用相关的因素比较组间差异。
2891 例患者在第 1 组（79.3%为男性），1620 例在第 2 组（75.7%为男性），1220 例在第 3 组（82.9%为男性）。预先通知的患者更有可能在工作时间就诊（p=0.004），而自行就诊者的心源性休克发生率最低（p<0.001）。预先通知的 FMC-BT 短于无预先通知（104 分钟 vs 132 分钟，p<0.001），自行就诊者的临床结局更好，而救护车组之间无差异。第 1 组和第 2 组在 30 天 MACCE 结局方面相似（第 1 组 7.4%，第 2 组 9.1%，p=0.05），死亡率也相似（第 1 组 4.6%，第 2 组 5.9%，p=0.07）。多变量分析显示，男性、右冠状动脉罪犯病变和工作时间就诊独立预测预先通知的使用（均 p<0.05）。
临床特征的差异，特别是性别、就诊时间和罪犯血管，可能影响救护车预先通知。救护车队列与自行就诊者相比，具有高危特征和更差的结局。建议改善院前 STEMI 诊断中的系统不平等，以最快速度进行 STEMI 治疗。
