Ohtaroglu Tokdil Kardelen, Tokdil Hasan, Durmaz Eser, Karadag Bilgehan, Kilickiran Avci Burcak, Ikitimur Baris, Ozmen Emre, Tekin Alpin Mert, Pirdal Betul Zehra, Ongen Zeki
Division of Cardiology, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, 34098 Istanbul, Turkey.
Division of Cardiology, Zonguldak Caycuma State Hospital, 67900 Zonguldak, Turkey.
Medicina (Kaunas). 2025 Mar 4;61(3):447. doi: 10.3390/medicina61030447.
: The purpose of this study was to determine the factors that cause delay time in patients admitted to the hospital with STEMI. In addition, the effect of this delay on the patient's prognosis has also been investigated. : a total of 301 patients diagnosed with STEMI treated with primary percutaneous coronary intervention (pPCI) were included in the study. Reinfarction, revascularization, cerebrovascular event, and cardiac death were determined as major cardiac clinical events. The follow-up period of our study was 475 ± 193 days. : Univariate analysis revealed that factors influencing delay time included BMI, hypertension diabetes, smoking habit and variability in pain intensity. In multivariate logistic regression analysis, BMI, diabetes, hypertension, smoking, variation in pain intensity, and infarct-related artery other than the LAD were identified as independent factors associated with increased delay times. We determined the cut-off values predicting the composite endpoint as 122.5 min for patient delay, 95.5 min for system delay, and 371 min for total ischemic time. It was observed that the in-hospital NT pro-BNP values of the patients presenting early were lower (181 vs. 594 pg/mL < 0.001), had a higher ejection fraction at the first measurement, and even improved at the sixth week of follow-up ( = 0.047). : Prolonged ischemia duration was associated with several factors. Early reperfusion in STEMI patients reduces both cardiac death and clinical events. Delays are influenced by patient awareness, emergency care efficiency, and hospital-specific factors. Improving education, response times, and hospital protocols is essential to minimize delays and improve outcomes.
本研究的目的是确定导致ST段抬高型心肌梗死（STEMI）住院患者延迟时间的因素。此外，还研究了这种延迟对患者预后的影响。本研究纳入了301例接受直接经皮冠状动脉介入治疗（pPCI）的STEMI确诊患者。再梗死、血管重建、脑血管事件和心源性死亡被确定为主要的心脏临床事件。我们研究的随访期为475±193天。单因素分析显示，影响延迟时间的因素包括体重指数（BMI）、高血压、糖尿病、吸烟习惯和疼痛强度的变异性。在多因素逻辑回归分析中，BMI、糖尿病、高血压、吸烟、疼痛强度变化以及除左前降支（LAD）外的梗死相关动脉被确定为与延迟时间增加相关的独立因素。我们确定预测复合终点的临界值为患者延迟122.5分钟、系统延迟95.5分钟和总缺血时间371分钟。观察到早期就诊患者的院内N末端B型利钠肽原（NT pro-BNP）值较低（181 vs. 594 pg/mL，<0.001），首次测量时射血分数较高，甚至在随访第六周时有所改善（=0.047）。缺血持续时间延长与多种因素有关。STEMI患者早期再灌注可降低心源性死亡和临床事件。延迟受患者意识、急诊护理效率和医院特定因素的影响。改善教育、响应时间和医院协议对于尽量减少延迟和改善预后至关重要。
