Department of Cardiology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
Department of Chest Pain Center, The Pizhou Affiliated Hospital of Xuzhou Medical University, Xuzhou, China.
BMJ Open. 2022 Nov 17;12(11):e063795. doi: 10.1136/bmjopen-2022-063795.
In line with the cardiac fast track, the 'green pathway for patients with heart attack' policy in China is implemented to reduce door-to-balloon time in patients with ST-segment elevation myocardial infarction (STEMI). However, the difference in prehospital delay between urban and rural areas of China and its impact on prognosis is unclear.
Prospective observational study.
This study was conducted in a tertiary hospital, the only nationally accredited chest pain centre with percutaneous coronary intervention (PCI) capacity in Pizhou, China.
394 patients with STEMI without patients with in-hospital STEMI or patients lost to follow-up were included.
Primary outcome was major adverse cardiovascular events (MACEs), including cardiac death, non-fatal myocardial infarction and heart failure.
Among 394 patients enrolled, 261 (66.2%) were men, the median age was 69 years (interquartile range: 61-77 years), and 269 (68.3%) were from rural areas. Symptom-to-door (S2D) time was significantly longer for rural patients than for urban patients (p<0.001). Cox regression analyses revealed living in rural areas was independently associated with prolonged S2D time (adjusted HR 0.59; 95% CI 0.43 to 0.81; p=0.001). HR of <1 indicates that the S2D time is longer for patients in the rural group (group of interest). During 1-year follow-up, the incidence of MACEs was higher in rural patients (p=0.008). The unadjusted OR for MACEs between rural and urban patients was 2.22 (95% CI 1.22 to 4.01). Adjusting for sex did not attenuate the association (OR 2.06; 95% CI 1.13 to 3.76), but after further adjusting for age, cardiac function classification, S2D time and performance of primary PCI, we found that odds were similar for rural and urban patients (OR 1.19; 95% CI 0.59 to 2.38).
Rural patients with STEMI had a longer S2D time, which led to a higher incidence of MACEs. This study provides rationales for taking all the measures to avoid prehospital delay.
与心脏快速通道一致，中国推行“心梗救治绿色通道”政策，以缩短 ST 段抬高型心肌梗死（STEMI）患者的门球时间。然而，中国城乡之间院前延误的差异及其对预后的影响尚不清楚。
前瞻性观察性研究。
本研究在一家三级医院进行，该医院是中国邳州市唯一一家具有经皮冠状动脉介入治疗（PCI）能力的国家级认证胸痛中心。
共纳入 394 例 STEMI 患者，均为院内 STEMI 患者或失访患者。
主要不良心血管事件（MACE）包括心脏性死亡、非致死性心肌梗死和心力衰竭。
394 例患者中，261 例（66.2%）为男性，中位年龄 69 岁（四分位距：6177 岁），269 例（68.3%）来自农村地区。农村患者的症状至门（S2D）时间明显长于城市患者（p<0.001）。Cox 回归分析显示，居住在农村地区与 S2D 时间延长独立相关（调整后的 HR 0.59；95%CI 0.430.81；p=0.001）。HR<1 表示农村组的 S2D 时间更长（感兴趣的组）。在 1 年随访期间，农村患者的 MACE 发生率更高（p=0.008）。农村和城市患者之间 MACE 的未经调整 OR 为 2.22（95%CI 1.224.01）。调整性别后，这种关联没有减弱（OR 2.06；95%CI 1.133.76），但进一步调整年龄、心功能分级、S2D 时间和直接 PCI 后，发现农村和城市患者的比值相似（OR 1.19；95%CI 0.59~2.38）。
STEMI 农村患者的 S2D 时间较长，导致 MACE 发生率较高。本研究为采取一切措施避免院前延误提供了依据。
