美国东南部ST段抬高型心肌梗死患者延迟进行经皮冠状动脉介入治疗的风险

Risk of delayed percutaneous coronary intervention for STEMI in the Southeast United States.

作者信息

Messinger Maxwell C, Ashburn Nicklaus P, Chait Joshua S, Snavely Anna C, Hapig-Ward Siena, Stopyra Jason P, Mahler Simon A

机构信息

Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC; Department of Family Medicine and Community Health, UMass Chan School of Medicine, Worcester, MA.

Department of Emergency Medicine, Wake Forest University School of Medicine, Winston-Salem, NC.

出版信息

Am Heart J. 2025 Nov;289:67-77. doi: 10.1016/j.ahj.2025.05.002. Epub 2025 May 13.

DOI:10.1016/j.ahj.2025.05.002

PMID:40373988

Abstract

BACKGROUND

While percutaneous coronary intervention (PCI) reperfusion within 90 minutes of first medical contact (FMC) is indicated for ST-segment elevation myocardial infarction (STEMI), long transport times in rural areas can make this unlikely. We sought to quantify Southeast US residents at risk of treatment delay due to transport.

METHODS

A cross-sectional study of Southeast US residents was conducted using American Community Survey data and geographic information systems (GIS) to estimate emergency medical services (EMS) transport times to primary PCI (PPCI) centers. All PPCI centers in the study area were included, as well as centers in surrounding states. The main outcomes were the number of residents residing more than 30 and 60 minutes from PPCI. These cutoffs are based on national median EMS scene times and door-to-device times and correspond to estimated FMC-to-device times of 90 and 120 minutes, respectively. A secondary outcome was identification of counties with greater than 50% and 90% of their population at risk of treatment delay.

RESULTS

Of 62,880,528 residents in the study area, we identified nearly 11 million at risk of delayed PCI (17.3%, 10,866,710 ± 58,143). Of those, 1,271,522 (± 51,858) live greater than 60 minutes from PPCI. We found that 8.4% (52/616) of counties have more than 50% of their population at risk of treatment delay. 42.3% (22/52) of those have more than 90% of at risk.

CONCLUSIONS

Nearly 11 million people in the Southeast US do not have timely access to PCI. This disparity may contribute to increased morbidity and mortality.

摘要

背景

虽然首次医疗接触（FMC）后90分钟内进行经皮冠状动脉介入治疗（PCI）再灌注适用于ST段抬高型心肌梗死（STEMI），但农村地区较长的转运时间可能使其难以实现。我们试图量化美国东南部因转运而有治疗延迟风险的居民。

方法

利用美国社区调查数据和地理信息系统（GIS）对美国东南部居民进行横断面研究，以估计紧急医疗服务（EMS）到主要PCI（PPCI）中心的转运时间。研究区域内的所有PPCI中心以及周边州的中心均被纳入。主要结果是居住距离PPCI中心超过30分钟和60分钟的居民数量。这些临界值基于全国EMS现场时间和门到设备时间的中位数，分别对应估计的FMC到设备时间为90分钟和120分钟。次要结果是识别其人口中有超过50%和90%有治疗延迟风险的县。

结果

在研究区域的62,880,528名居民中，我们确定了近1100万人有PCI延迟风险（17.3%，10,866,710 ± 58,143）。其中，1,271,522人（± 51,858）居住距离PPCI中心超过60分钟。我们发现8.4%（52/616）的县其人口中有超过50%有治疗延迟风险。其中42.3%（22/52）的县有超过90%有风险。