Beygui Farzin, Roule Vincent, Ivanes Fabrice, Dechery Thierry, Bizeau Olivier, Roussel Laurent, Dequenne Philippe, Arnould Marc-Antoine, Combaret Nicolas, Collet Jean Philippe, Commeau Philippe, Cayla Guillaume, Montalescot Gilles, Benamer Hakim, Motreff Pascal, Angoulvant Denis, Marcollet Pierre, Chassaing Stephan, Blanchart Katrien, Koning René, Rangé Grégoire
Cardiology Department, CHU de Caen, Caen, France.
Cardiology Department, CHU de Tours, Tours, France.
Front Cardiovasc Med. 2022 Mar 11;9:793067. doi: 10.3389/fcvm.2022.793067. eCollection 2022.
First medical contact (FMC)-to-balloon time is associated with outcome of ST-elevation myocardial infarction (STEMI). We assessed the impact on mortality and the determinants of indirect vs. direct transfer to the cardiac catheterization laboratory (CCL).
We analyzed data from 2,206 STEMI patients consecutively included in a prospective multiregional percutaneous coronary intervention (PCI) registry. The primary endpoint was 1-year mortality. The impact of indirect admission to CCL on mortality was assessed using Cox models adjusted on FMC-to-balloon time and covariables unequally distributed between groups. A multivariable logistic regression model assessed determinants of indirect transfer.
A total of 359 (16.3%) and 1847 (83.7%) were indirectly and directly admitted for PCI. Indirect admission was associated with higher risk features, different FMCs and suboptimal pre-PCI antithrombotic therapy.At 1-year follow-up, 51 (14.6%) and 137 (7.7%) were dead in the indirect and direct admission groups, respectively (adjusted-HR 1.73; 95% CI 1.22-2.45). The association of indirect admission with mortality was independent of pre-FMC and FMC characteristics. Older age, paramedics- and private physician-FMCs were independent determinants of indirect admission (adjusted-HRs 1.02 per year, 95% CI 1.003-1.03; 5.94, 95% CI 5.94 3.89-9.01; 3.41; 95% CI 1.86-6.2, respectively).
Our study showed that, indirect admission to PCI for STEMI is associated with 1-year mortality independent of FMC to balloon time and should be considered as an indicator of quality of care. Indirect admission is associated with higher-risk features and suboptimal antithrombotic therapy. Older age, paramedics-FMC and self-presentation to a private physician were independently associated with indirect admission. Our study, supports population education especially targeting elderly, more adequately dispatched FMC and improved pre-CCL management.
首次医疗接触（FMC）至球囊扩张时间与ST段抬高型心肌梗死（STEMI）的预后相关。我们评估了其对死亡率的影响以及间接与直接转运至心脏导管实验室（CCL）的决定因素。
我们分析了前瞻性多区域经皮冠状动脉介入治疗（PCI）登记中连续纳入的2206例STEMI患者的数据。主要终点为1年死亡率。使用根据FMC至球囊扩张时间及组间分布不均的协变量进行调整的Cox模型评估间接入住CCL对死亡率的影响。多变量逻辑回归模型评估间接转运的决定因素。
共有359例（16.3%）和1847例（83.7%）分别间接和直接入住接受PCI治疗。间接入住与更高风险特征、不同的FMC以及PCI前抗栓治疗欠佳相关。在1年随访时，间接入住组和直接入住组分别有51例（14.6%）和137例（7.7%）死亡（校正风险比1.73；95%可信区间1.22 - 2.45）。间接入住与死亡率的关联独立于FMC前和FMC特征。年龄较大、急救人员和私人医生进行的FMC是间接入住的独立决定因素（每年校正风险比分别为1.02，95%可信区间1.003 - 1.03；5.94，95%可信区间3.89 - 9.01；3.41，95%可信区间1.86 - 6.2）。
我们的研究表明，STEMI患者间接入住接受PCI治疗与1年死亡率相关，独立于FMC至球囊扩张时间，应被视为医疗质量的一个指标。间接入住与更高风险特征和欠佳的抗栓治疗相关。年龄较大、急救人员进行的FMC以及自行前往私人医生处就诊与间接入住独立相关。我们的研究支持针对老年人开展人群教育、更合理地派遣FMC以及改善CCL前管理。
