Hai Yoshiaki, Sakakura Kenichi, Jinnouchi Hiroyuki, Taniguchi Yousuke, Yamamoto Kei, Tsukui Takunori, Hatori Masashi, Kasahara Taku, Watanabe Yusuke, Ishibashi Shun, Seguchi Masaru, Fujita Hideo
Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya, Saitama City, 330-8503, Japan.
Cardiovasc Interv Ther. 2025 Apr;40(2):277-286. doi: 10.1007/s12928-024-01075-5. Epub 2024 Dec 11.
Primary percutaneous coronary intervention (PCI) is the cornerstone of treatment for ST-segment elevation myocardial infarction (STEMI). Previous studies suggest that direct transport by ambulance to a primary PCI facility is associated with better clinical outcomes in patients with STEMI. However, those studies included seriously ill patients for whom direct transport is the only option. We included 462 patients with STEMI who were supposed to select either direct transport by ambulance or indirect transport via primary care doctor, and compared the clinical outcomes between the direct transfer group (n = 172) and the indirect transfer group (n = 290). The primary endpoint was major adverse cardiovascular events (MACE), which was defined as the composite of all-cause death, non-fatal myocardial infarction, re-admission for heart failure, and target vessel revascularization. The median follow-up duration was 540 days (86-1266 days). Age was significantly higher in the indirect transfer group [72.0 (64-80) years] than in the direct transfer group [69.5 (58.3-77) years] (p = 0.013). Onset to balloon time was significantly shorter in the direct transport group (p < 0.001). The Kaplan-Meier curves revealed that MACE were similarly observed between the two groups (31.4% vs. 27.2%; p = 0.330). After adjusting for potential confounders, indirect transfer was not associated with MACE (adjusted hazard ratio: 0.740, 95% confidence interval: 0.485-1.128, p = 0.161). In conclusion, indirect transfer was not associated with poor clinical outcomes in patients with STEMI who were supposed to select either direct transport or indirect transport.
直接经皮冠状动脉介入治疗（PCI）是ST段抬高型心肌梗死（STEMI）治疗的基石。既往研究表明，对于STEMI患者，由救护车直接转运至具备直接PCI能力的医疗机构与更好的临床结局相关。然而，这些研究纳入的是病情严重的患者，对于他们而言直接转运是唯一选择。我们纳入了462例STEMI患者，这些患者原本应选择由救护车直接转运或经初级保健医生进行间接转运，并比较了直接转运组（n = 172）和间接转运组（n = 290）的临床结局。主要终点是主要不良心血管事件（MACE），其定义为全因死亡、非致死性心肌梗死、因心力衰竭再次入院以及靶血管血运重建的复合事件。中位随访时间为540天（86 - 1266天）。间接转运组的年龄[72.0（64 - 80）岁]显著高于直接转运组[69.5（58.3 - 77）岁]（p = 0.013）。直接转运组从发病到球囊扩张时间显著更短（p < 0.001）。Kaplan-Meier曲线显示两组MACE发生率相似（31.4%对27.2%；p = 0.330）。在对潜在混杂因素进行校正后，间接转运与MACE无关（校正风险比：0.740，95%置信区间：0.485 - 1.128，p = 0.161）。总之，对于原本应选择直接转运或间接转运的STEMI患者，间接转运与不良临床结局无关。
