Sabe Marwa A, Kaeberlein Frank J, Sabe Sharif A, Kelly Allyson, Summerfield Tracy, Sabe Ahmed A
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.
Emergency Services Institute, Cleveland Clinic Mercy Hospital, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
JACC Adv. 2025 Jun;4(6 Pt 1):101774. doi: 10.1016/j.jacadv.2025.101774. Epub 2025 May 13.
Percutaneous coronary intervention is the preferred treatment for acute ST-segment elevation myocardial infarction (STEMI), and shorter door-to-balloon time (D2B) is associated with lower mortality. We implemented a catheterization laboratory within the emergency department (ED) as a novel strategy to reduce D2B.
The purpose of this paper was to compare D2B and mortality in STEMI patients presenting to ED vs standard catheterization labs at a community hospital.
We prospectively reviewed consecutive patients presenting with STEMI to our institution between 1998 and 2011 and treated with primary percutaneous coronary intervention. The primary endpoints were D2B and time to death. A multivariable linear regression model was used to assess the relationship between catheterization lab location and D2B. The relationship between D2B and mortality was examined using a Cox proportional hazards model.
We included 1,053 STEMI patients (553 in ED vs 500 in standard catheterization labs). Both groups had similar age, sex, race, diabetes, left main disease, and Killip class on presentation. Standard catheterization lab patients were more likely to have left ventricular ejection fraction <40% (11% vs 6.5%). D2B was shorter in ED vs standard cath lab patients (54 vs 83 minutes, P < 0.001). ED catheterization lab patients were more likely to have <30-minute D2B (17% vs <1%, P < 0.001). After covariate adjustment, ED catheterization lab patients had lower 30-day (adjusted hazard ratio [adj HR]: 0.54, 95% confidence interval [CI] 0.29-0.99), 1-year (adj HR: 0.58, 95% CI: 0.37-0.91), and 10-year mortality (adj HR: 0.39, 95% CI: 0.29-0.53) than standard catheterization lab patients.
Implementation of an ED catheterization lab is a feasible strategy which may reduce D2B and STEMI mortality.
经皮冠状动脉介入治疗是急性ST段抬高型心肌梗死（STEMI）的首选治疗方法，缩短门球时间（D2B）与降低死亡率相关。我们在急诊科（ED）设立了导管室，作为缩短D2B的一种新策略。
本文旨在比较社区医院急诊科与标准导管室中STEMI患者的D2B和死亡率。
我们前瞻性地回顾了1998年至2011年间在我院就诊并接受直接经皮冠状动脉介入治疗的连续性STEMI患者。主要终点是D2B和死亡时间。采用多变量线性回归模型评估导管室位置与D2B之间的关系。使用Cox比例风险模型检查D2B与死亡率之间的关系。
我们纳入了1053例STEMI患者（急诊科553例，标准导管室500例）。两组患者就诊时的年龄、性别、种族、糖尿病、左主干病变和Killip分级相似。标准导管室患者左心室射血分数<40%的可能性更高（11%对6.5%）。急诊科患者的D2B比标准导管室患者短（54分钟对83分钟，P<0.001）。急诊科导管室患者D2B<30分钟的可能性更高（17%对<1%，P<0.001）。在进行协变量调整后，急诊科导管室患者的30天（调整后风险比[adj HR]：0.54，95%置信区间[CI]0.29 - 0.99）、1年（adj HR：0.58，95%CI：0.37 - 0.91）和10年死亡率（adj HR：0.39，95%CI：0.29 - 0.53）均低于标准导管室患者。
在急诊科设立导管室是一种可行的策略，可能会降低D2B和STEMI死亡率。
