Rotholz Aviad, Lerman Tsahi T, Awesat Jenan, Eisen Alon, Beigel Roy, Kanani Elias, Braver Omri, Orvin Katia
Rabin Medical Center Cardiology Division Beilinson and Hasharon Petah Tikva Israel.
Faculty of Medical and Health Sciences Tel Aviv University Tel Aviv Israel.
J Am Heart Assoc. 2025 Jul;14(13):e040813. doi: 10.1161/JAHA.124.040813. Epub 2025 Jun 18.
The ambulance system is vital for the early management of patients with ST-segment-elevation myocardial infarction, reducing delays in diagnosis and treatment. This study examined the impact of transport mode on reperfusion therapy and mortality among patients with ST-segment-elevation myocardial infarction from 2000 to 2021.
Data from the ACSIS (Acute Coronary Syndrome Israeli Survey) registry 2000 to 2021 were analyzed. Three transport methods of patients with ST-segment-elevation myocardial infarction were evaluated. The impact on patient outcomes was assessed. Temporal trends from early (2000-2010) and late (2013-2021) periods were compared.
Of 8035 patients with ST-segment-elevation myocardial infarction, 52.9% were transported by mobile intensive care units, 13.1% by basic life support ambulances, and 34% self-transported. Use of mobile intensive care units increased from 48.7% to 60.9% (<0.001), while self-transport decreased from 36.8% to 28.7% (<0.001). Time from hospital arrival to primary percutaneous coronary intervention significantly decreased for mobile intensive care unit patients (60 to 36 minutes; <0.001) and for basic life support patients (90 to 73 minutes; =0.002), while self-transport showed no significant change. Adjusted analysis revealed a decrease in 30-day major adverse cardiovascular events (odds ratio, 0.53; <0.001) and 1-year mortality rates (hazard ratio, 0.84; 0.05) for the entire cohort with no difference within or upon comparing transport methods between periods. Primary percutaneous coronary intervention rates and guideline-directed medical therapy also rose significantly (<0.001).
Improved major adverse cardiovascular event and mortality rates are attributed to enhanced in-hospital and postdischarge care, including primary percutaneous coronary intervention and guideline-directed medical therapy rather than transport improvements, although these contribute to more stable arrival conditions.
救护车系统对于ST段抬高型心肌梗死患者的早期管理至关重要，可减少诊断和治疗延迟。本研究探讨了2000年至2021年期间转运方式对ST段抬高型心肌梗死患者再灌注治疗及死亡率的影响。
分析了2000年至2021年以色列急性冠状动脉综合征调查（ACSIS）登记处的数据。评估了ST段抬高型心肌梗死患者的三种转运方式。评估了对患者结局的影响。比较了早期（2000 - 2010年）和晚期（2013 - 2021年）的时间趋势。
在8035例ST段抬高型心肌梗死患者中，52.9%由移动重症监护单元转运，13.1%由基础生命支持救护车转运，34%为自行前往。移动重症监护单元的使用比例从48.7%增至60.9%（<0.001），而自行前往的比例从36.8%降至28.7%（<0.001）。移动重症监护单元患者从入院到接受首次经皮冠状动脉介入治疗的时间显著缩短（从60分钟降至36分钟；<0.001），基础生命支持患者的这一时间段也缩短（从90分钟降至73分钟；=0.002），而自行前往的患者无显著变化。校正分析显示，整个队列的30天主要不良心血管事件发生率降低（比值比，0.53；<0.001），1年死亡率降低（风险比，0.84；0.05），不同时期的转运方式之间及比较后均无差异。首次经皮冠状动脉介入治疗率和指南指导的药物治疗也显著提高（<0.001）。
主要不良心血管事件和死亡率的改善归因于住院期间及出院后护理的加强，包括首次经皮冠状动脉介入治疗和指南指导的药物治疗，而非转运的改善，尽管转运改善有助于患者到达时状况更稳定。
