Prakash Binayendu, Mohanta Reeta R, Lal Prem P, Shah Mandar M
Department of Cardiology, Tata Main Hospital, Jamshedpur, IND.
Cureus. 2022 Jan 24;14(1):e21539. doi: 10.7759/cureus.21539. eCollection 2022 Jan.
Acute coronary syndrome is a major cause of morbidity and mortality all over the world. Timely intervention in ST-elevation myocardial infarction (STEMI) in the form of primary angioplasty is the gold standard of treatment to reduce mortality and morbidity. "Time is muscle" is the phrase to impress upon the importance of time in treating patients with STEMI. Traditional treatment target included "door to balloon time" of 90 min or less. This "door to balloon time" is now rephrased as the "wire crossing time" (WCT). The European Society of Cardiology (ESC) updated its guidelines further, reducing the target of wire crossing time to 60 min. The present study is a brief report on the door to wire crossing time status in one of the tertiary care centers of a nonmetro city. Retrospective analysis of case records was done for 79 patients admitted with acute MI who underwent primary angioplasty between November 2018 and June 2019 (pre-corrective action group). Various reasons for the delay, right from the time of the patient reaching the emergency room (ER) to the time of wire crossing, were analysed and measures were taken to reduce the delay. The post-corrective action group comprised 77 patients. The major causes of a prolonged WCT in our setup were delayed diagnosis of STEMI in ER, delay in giving consent by the patient's relatives, financial issues, and availability of cath lab technicians during the off-duty hour. The delay in WCT in our center was 121 min. Remedial actions were taken to mitigate the problems at each step, which resulted in a reduction of delay by 20 min, i.e., to 101 min leading to a significant difference in the outcome in view of morbidity and mortality.
急性冠状动脉综合征是全球发病和死亡的主要原因。以直接血管成形术的形式对ST段抬高型心肌梗死（STEMI）进行及时干预是降低死亡率和发病率的治疗金标准。“时间就是心肌”这句话强调了时间在治疗STEMI患者中的重要性。传统的治疗目标包括“门球时间”在90分钟或更短。现在这个“门球时间”被重新表述为“导丝通过时间”（WCT）。欧洲心脏病学会（ESC）进一步更新了其指南，将导丝通过时间的目标降低到60分钟。本研究是关于一个非大都市三级护理中心之一的门到导丝通过时间状况的简要报告。对2018年11月至2019年6月期间接受直接血管成形术的79例急性心肌梗死住院患者（纠正前行动组）的病例记录进行了回顾性分析。分析了从患者到达急诊室到导丝通过的各个延迟原因，并采取措施减少延迟。纠正后行动组包括77例患者。在我们的机构中，WCT延长的主要原因是急诊室对STEMI的诊断延迟、患者亲属同意延迟、财务问题以及非值班时间导管室技术人员的可用性。我们中心的WCT延迟为121分钟。在每个步骤都采取了补救措施来缓解问题，这使得延迟减少了20分钟，即降至101分钟，鉴于发病率和死亡率，这导致了结果上的显著差异。
