Department of Cardiology, Austin Health, Melbourne, Australia.
Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Monash University, Melbourne, Australia.
Cardiovasc Revasc Med. 2022 Aug;41:136-141. doi: 10.1016/j.carrev.2022.01.024. Epub 2022 Jan 31.
Primary percutaneous coronary intervention (PCI) for patients with ST-elevation myocardial infarction (STEMI) is recommended within 90 min of first medical contact. Those without pre-hospital notification (PN) are less likely to meet reperfusion targets and are an understudied subset of the STEMI population.
An observational cohort study from a multicentre PCI registry of consecutive patients undergoing primary PCI for STEMI between 2012 and 2017. Exclusion criteria included out-of-hospital cardiac arrest, prior thrombolysis, symptom onset >12 h prior, and cardiogenic shock.
2519 patients were included: 1392 (55.3%) without PN (no-PN group) and 1127 (44.7%) with PN (PN group). Those without PN had longer median DTBT (78 min vs 51 min, p < 0.001) and STBT (206 min vs 161 min, p < 0.001), with only 55% meeting DTBT targets out-of-hours in the no-PN group. No-PN patients had lower rates of AHA/ACC type B2/C lesions, GP IIb/IIIa use, aspiration thrombectomy and had smaller stent diameter (all p ≤ 0.003), suggesting smaller areas of ischemic myocardium. There were no significant differences in 30-day MACE (no-PN 5.6% vs PN 6.5%, p = 0.36) or long-term National Death Index linked mortality (no-PN 6.2% vs PN 7.9%, p = 0.09). Lack of PN did not independently predict long-term mortality.
Despite comparably excellent outcomes overall, those without PN had longer ischemic times and were less likely to meet DTBT targets, especially after hours. Ischemic times may be a better evaluation of PN networks than hard clinical outcomes, and efficient systems of care tailored to the individual health service are essential to ensure timely reperfusion of patients with STEMI.
对于 ST 段抬高型心肌梗死（STEMI）患者，建议在首次医疗接触后 90 分钟内进行经皮冠状动脉介入治疗（PCI）。那些没有院前通知（PN）的患者不太可能达到再灌注目标，并且是 STEMI 患者中研究较少的亚组。
这是一项来自多中心 PCI 登记处的连续 STEMI 患者的观察队列研究，这些患者在 2012 年至 2017 年间接受了经皮冠状动脉介入治疗。排除标准包括院外心脏骤停、先前溶栓、症状发作超过 12 小时和心源性休克。
共纳入 2519 例患者：1392 例（55.3%）无 PN（无 PN 组）和 1127 例（44.7%）有 PN（PN 组）。无 PN 组的中位 DTBT（78 分钟 vs 51 分钟，p < 0.001）和 STBT（206 分钟 vs 161 分钟，p < 0.001）更长，只有 55%的无 PN 组在非工作时间达到 DTBT 目标。无 PN 组患者 AHA/ACC 类型 B2/C 病变、GP IIb/IIIa 应用、抽吸血栓切除术和支架直径较小的比例较低（均 p ≤ 0.003），提示缺血心肌面积较小。30 天 MACE（无 PN 组 5.6% vs PN 组 6.5%，p = 0.36）或长期国家死亡指数（National Death Index）链接死亡率（无 PN 组 6.2% vs PN 组 7.9%，p = 0.09）无显著差异。缺乏 PN 并不能独立预测长期死亡率。
尽管总体结果相当出色，但无 PN 患者的缺血时间更长，且不太可能达到 DTBT 目标，尤其是在工作时间之外。与硬临床结局相比，PN 网络的缺血时间可能是更好的评估方法，并且需要针对个别卫生服务量身定制的高效护理系统，以确保 STEMI 患者及时再灌注。
