在南非约翰内斯堡克里斯·哈尼巴哈纳瓦特学术医院，ST 段抬高型心肌梗死患者的溶栓时间及导致延迟的因素。

Time to thrombolysis and factors contributing to delays in patients presenting with ST-elevation myocardial infarction at Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.

机构信息

Department of Internal Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.

Department of Internal Medicine and Division of Pulmonology, Faculty of Health Sciences, University of the Witwatersrand and Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.

出版信息

S Afr Med J. 2023 Sep 4;113(9):53-58. doi: 10.7196/SAMJ.2023.v113i9.500.

DOI:10.7196/SAMJ.2023.v113i9.500

PMID:37882136

Abstract

BACKGROUND

Acute coronary syndrome is a public health burden both worldwide and in South Africa (SA). Guidelines recommend thrombolysis within 1 hour of symptom onset and 30 minutes of hospital arrival for patients with ST-elevation myocardial infarction (STEMI) in order to prevent morbidity and mortality. There is a paucity of data pertaining to the time between onset of chest pain and thrombolysis in STEMI patients in SA.

OBJECTIVES

To elucidate the time to thrombolytic therapy, establish the reasons for treatment delays, and calculate the loss of benefit of thrombolysis associated with delays in treatment of patients presenting with STEMI at Chris Hani Baragwanath Academic Hospital (CHBAH), Johannesburg, SA.

METHOD

A prospective observational study of 100 consecutive patients with STEMI was conducted at CHBAH (2021 - 2022).

RESULTS

The mean (standard deviation) age was 55.6 (11.6) years, with a male predominance (78%). Thrombolytic therapy was administered to 51 patients, with a median (interquartile range (IQR)) time to thrombolysis of 360 (258 - 768) minutes; 10 of the patients who received a thrombolytic (19.6%) did so within 30 minutes of arrival at the hospital. The median (IQR) time from symptom onset to calling for help was 60 (30 - 240) minutes, the median time from arrival of help to hospital arrival was 114 (48 - 468) minutes, and the median in-hospital delay to thrombolysis after arrival was 105 (45 - 240) minutes. Numerous reasons that led to delay in treatment were identified, but the most frequent was prehospital delays related to patient factors. Late presentation resulted in 26/49 patients (53.1%) not receiving thrombolytic therapy. Five patients died and 43 suffered from heart failure. Thirty per 1 000 participants could have been saved had they received thrombolytic therapy within 1 hour from the onset of chest pain.

CONCLUSION

Prehospital and hospital-related factors played a significant role in delays to thrombolysis that led to increased morbidity and mortality of patients with STEMI.

摘要

背景

急性冠状动脉综合征在全球和南非（SA）都是一个公共卫生负担。指南建议，对于出现 ST 段抬高型心肌梗死（STEMI）的患者，应在症状发作后 1 小时内并在到达医院后 30 分钟内进行溶栓治疗，以预防发病率和死亡率。关于南非 STEMI 患者胸痛发作与溶栓治疗之间的时间间隔，数据很少。

目的

阐明溶栓治疗的时间，确定治疗延迟的原因，并计算与治疗延迟相关的溶栓益处损失，以治疗在南非约翰内斯堡克里斯·哈尼·巴哈旺加医院（CHBAH）就诊的 STEMI 患者。

方法

对 2021 年至 2022 年在 CHBAH 就诊的 100 例连续 STEMI 患者进行了前瞻性观察研究。

结果

患者平均（标准差）年龄为 55.6（11.6）岁，男性居多（78%）。对 51 例患者进行了溶栓治疗，溶栓中位数（四分位距（IQR））时间为 360（258-768）分钟；10 例（19.6%）患者在到达医院后 30 分钟内接受了溶栓治疗。从症状发作到呼救的中位数（IQR）时间为 60（30-240）分钟，从求助到达医院的中位数（IQR）时间为 114（48-468）分钟，到达医院后中位数（IQR）的院内延迟溶栓时间为 105（45-240）分钟。确定了导致治疗延迟的诸多原因，但最常见的是与患者因素相关的院前延迟。由于就诊较晚，49 例患者中有 26 例（53.1%）未接受溶栓治疗。5 例患者死亡，43 例患者发生心力衰竭。如果这些患者在胸痛发作后 1 小时内接受溶栓治疗，每 1000 例患者中有 30 例可能会被挽救。