Yiadom Maame Yaa A B, Gong Wu, Patterson Brian W, Baugh Christopher W, Mills Angela M, Gavin Nicholas, Podolsky Seth R, Mumma Bryn E, Tanski Mary, Salazar Gilberto, Azzo Caitlin, Dorner Stephen C, Hadley Kelsea, Bloos Sean M, Bunney Gabrielle, Vogus Timothy J, Liu Dandan
Department of Emergency Medicine Stanford University Stanford California USA.
Department of Biostatistics, Vanderbilt University Medical Center Nashville Tennessee USA.
J Am Coll Emerg Physicians Open. 2024 May 8;5(3):e13174. doi: 10.1002/emp2.13174. eCollection 2024 Jun.
Earlier electrocardiogram (ECG) acquisition for ST-elevation myocardial infarction (STEMI) is associated with earlier percutaneous coronary intervention (PCI) and better patient outcomes. However, the exact relationship between timely ECG and timely PCI is unclear.
We quantified the influence of door-to-ECG (D2E) time on ECG-to-PCI balloon (E2B) intervention in this three-year retrospective cohort study, including patients from 10 geographically diverse emergency departments (EDs) co-located with a PCI center. The study included 576 STEMI patients excluding those with a screening ECG before ED arrival or non-diagnostic initial ED ECG. We used a linear mixed-effects model to evaluate D2E's influence on E2B with piecewise linear terms for D2E times associated with time intervals designated as ED intake (0-10 min), triage (11-30 min), and main ED (>30 min). We adjusted for demographic and visit characteristics, past medical history, and included ED location as a random effect.
The median E2B interval was longer (76 vs 68 min, < 0.001) in patients with D2E >10 min than in those with timely D2E. The proportion of patients identified at the intake, triage, and main ED intervals was 65.8%, 24.9%, and 9.7%, respectively. The D2E and E2B association was statistically significant in the triage phase, where a 1-minute change in D2E was associated with a 1.24-minute change in E2B (95% confidence interval [CI]: 0.44-2.05, = 0.003).
Reducing D2E is associated with a shorter E2B. Targeting D2E reduction in patients currently diagnosed during triage (11-30 min) may be the greatest opportunity to improve D2B and could enable 24.9% more ED STEMI patients to achieve timely D2E.
对ST段抬高型心肌梗死（STEMI）患者更早进行心电图（ECG）检查与更早进行经皮冠状动脉介入治疗（PCI）及更好的患者预后相关。然而，及时进行心电图检查与及时进行PCI的确切关系尚不清楚。
在这项为期三年的回顾性队列研究中，我们量化了门到心电图（D2E）时间对心电图到PCI球囊扩张（E2B）干预的影响，研究对象包括来自10个地理位置不同且与PCI中心同处一地的急诊科（ED）的患者。该研究纳入了576例STEMI患者，排除了在到达急诊科之前进行过筛查心电图或初始急诊科心电图未明确诊断的患者。我们使用线性混合效应模型来评估D2E对E2B的影响，并对与指定为急诊科接诊（0 - 10分钟）、分诊（11 - 30分钟）和主要急诊科阶段（>30分钟）的时间间隔相关的D2E时间采用分段线性项。我们对人口统计学和就诊特征、既往病史进行了调整，并将急诊科位置作为随机效应纳入。
D2E>10分钟的患者，其E2B间隔中位数更长（76分钟对68分钟，<0.001），而D2E及时的患者则较短。在接诊、分诊和主要急诊科阶段识别出的患者比例分别为65.8%、24.9%和9.7%。在分诊阶段，D2E与E2B的关联具有统计学意义，D2E每变化1分钟，E2B变化1.24分钟（95%置信区间[CI]：0.44 - 2.05，P = 0.003）。
缩短D2E与缩短E2B相关。针对目前在分诊期间（11 - 30分钟）确诊的患者缩短D2E，可能是改善门到球囊扩张时间（D2B）的最大机会，并且可以使多24.9%的急诊科STEMI患者实现及时的D2E。
