Cardiology Department The Prince Charles Hospital Brisbane Queensland Australia.
School of Clinical Medicine, Faculty of Medicine University of Queensland Brisbane Queensland Australia.
J Am Heart Assoc. 2023 Jul 18;12(14):e029346. doi: 10.1161/JAHA.122.029346. Epub 2023 Jul 14.
Background Prehospital activation of the cardiac catheter laboratory is associated with significant improvements in ST-segment-elevation myocardial infarction (STEMI) performance measures. However, there are equivocal data, particularly within Australia, regarding its influence on mortality. We assessed the association of prehospital activation on performance measures and mortality in patients with STEMI treated with primary percutaneous coronary intervention from the Queensland Cardiac Outcomes Registry (QCOR). Methods and Results Consecutive ambulance-transported patients with STEMI treated with primary percutaneous coronary intervention were analyzed from January 1, 2017 to December 31, 2020 from the QCOR. The total and direct effects of prehospital activation on the primary outcomes (30-day and 1-year cardiovascular mortality) were estimated using logistic regression analyses. Secondary outcomes were STEMI performance measures. Among 2498 patients (mean age: 62.2±12.4 years; 79.2% male), 73% underwent prehospital activation. Median door-to-balloon time (34 minutes [26-46] versus 86 minutes [68-113]; <0.001), first-electrocardiograph-to-balloon time (83.5 minutes [72-98] versus 109 minutes [81-139]; <0.001), and proportion of patients meeting STEMI targets (door-to-balloon <60 minutes 90% versus 16%; <0.001), electrocardiograph-to-balloon time <90 minutes (62% versus 33%; <0.001) were significantly improved with prehospital activation. Prehospital activation was associated with significantly lower 30-day (1.6% versus 6.6%; <0.001) and 1-year cardiovascular mortality (2.9% versus 9.5%; <0.001). After adjustment, no prehospital activation was strongly associated with increased 30-day (odds ratio [OR], 3.6 [95% CI, 2.2-6.0], <0.001) and 1-year cardiovascular mortality (OR, 3.0 [95% CI, 2.0-4.6]; <0.001). Conclusions Prehospital activation of cardiac catheterization laboratory for primary percutaneous coronary intervention was associated with significantly shorter time to reperfusion, achievement of STEMI performance measures, and lower 30-day and 1-year cardiovascular mortality.
背景 心脏导管实验室的院前激活与 ST 段抬高型心肌梗死（STEMI）绩效指标的显著改善相关。然而，在澳大利亚，其对死亡率的影响的数据尚存在争议。我们评估了心脏导管实验室的院前激活对接受直接经皮冠状动脉介入治疗的 STEMI 患者的绩效指标和死亡率的影响，这些患者来自昆士兰心脏结局登记（QCOR）。
方法 从 2017 年 1 月 1 日至 2020 年 12 月 31 日，从 QCOR 中分析了连续的由救护车转运的 STEMI 患者，并接受直接经皮冠状动脉介入治疗。使用逻辑回归分析评估了心脏导管实验室的院前激活对主要结局（30 天和 1 年心血管死亡率）的总效应和直接效应。次要结局为 STEMI 绩效指标。在 2498 例患者（平均年龄：62.2±12.4 岁；79.2%为男性）中，73%进行了心脏导管实验室的院前激活。中位门球时间（34 分钟[26-46] 与 86 分钟[68-113]；<0.001）、首次心电图至球囊时间（83.5 分钟[72-98] 与 109 分钟[81-139]；<0.001）和达到 STEMI 目标的患者比例（门球时间<60 分钟 90%与 16%；<0.001））显著改善。心脏导管实验室的院前激活与 30 天（1.6%比 6.6%；<0.001）和 1 年心血管死亡率（2.9%比 9.5%；<0.001）显著降低相关。校正后，心脏导管实验室的院前激活与 30 天（比值比[OR]，3.6[95%CI，2.2-6.0]，<0.001）和 1 年心血管死亡率（OR，3.0[95%CI，2.0-4.6]；<0.001）增加强烈相关。
结论 直接经皮冠状动脉介入治疗前心脏导管实验室的激活与再灌注时间明显缩短、STEMI 绩效指标的实现以及 30 天和 1 年心血管死亡率的降低显著相关。
