Jánosi András, Csató Gábor, Ferenci Tamás, Pápai György, Guti Sándor, Vajer Péter, Andréka Péter
1 Gottsegen György Országos Kardiovaszkuláris Intézet, Nemzeti Szívinfarktus Regiszter Budapest, Haller u. 29., 1096 Magyarország.
2 Országos Mentőszolgálat Budapest Magyarország.
Orv Hetil. 2025 Jun 22;166(25):963-969. doi: 10.1556/650.2025.33315.
Introduction: The effectiveness of the treatment of patients with myocardial infarction and their life prospects are significantly influenced by the total ischemic time, which is calculated from the onset of the complaint to the opening of the vessel. Objective: In our study, we analyzed the length of the components of the total ischemic time and compared it with the results of the study five years earlier. Method: We analyzed the data of 8705 patients treated for acute myocardial infarction registered between 01. 07. 2022 and 30. 06. 2023 (4334 [49.8%] STEMI, 3428 [39.4%] women), for whom all data were available for the calculation of each time interval. In the case of times, the median values and notable quartiles (lower quartile, Q1 and upper quartile, Q3) were given, similarly to our previous study. The diagnosis was established during hospitalization, based on the valid criteria. We examined patient delay, i.e., the time elapsing from the complaint to the notification of the ambulance service, from the notification to the arrival at the scene, and from the scene to the arrival at the hospital. During hospital care, we examined the time between the admission of the patient and the opening of the vessel (door-to-needle time). The data were also provided in national and county breakdowns. Results: The median patient delay for STEMI patients nationwide was 140 minutes (Q1: 51; Q3: 458). The median ambulance arrival time was 13.2 minutes (Q1: 8.0; Q3: 21.1), the median on-site care time was 25.5 minutes (Q1: 17.6; Q3: 34.9), and the median on-site to hospital time was 31.0 minutes (Q1: 19.5; Q3: 43.7). The range of arrival time per county was 8.8–17.9 minutes. The median door-to-needle time for STEMI patients nationwide was 51.5 minutes (Q1: 28.7; Q3: 121.7). In the NSTEMI group, the median patient delay was 373 minutes (Q1: 106; Q3: 1184), and the time to arrival at the scene was 14.2 minutes (Q1: 8.5; Q3: 24.8). In the case of STEMI, the patient delay increased by almost 40 minutes compared to the previous period (101 vs. 140 minutes), and the median time to arrival of the ambulance at the scene (13.0 vs. 13.2 minutes) did not change significantly. The door-to-needle time in the present study was almost by 15 minutes longer than before (37.0 vs. 51.5 minutes). In the STEMI group, the vessel was opened within 2 hours in 4.1% of the patients and within 4 hours in 38.3% of the patients. Conclusion: The patient’s delay is the determining factor in terms of total ischemic time, therefore, in a significant proportion of treatments, revascularization did not take place at the optimal time. Orv Hetil. 2025; 166(25): 963–969.
心肌梗死患者的治疗效果及其生命前景受到总缺血时间的显著影响，总缺血时间是从症状发作到血管开通计算得出的。目的：在我们的研究中，我们分析了总缺血时间各组成部分的时长，并将其与五年前的研究结果进行比较。方法：我们分析了2022年7月1日至2023年6月30日期间登记治疗的8705例急性心肌梗死患者的数据（4334例[49.8%]ST段抬高型心肌梗死，3428例[39.4%]为女性），所有数据均可用于计算每个时间间隔。对于时间，给出了中位数和显著四分位数（下四分位数，Q1和上四分位数，Q3），与我们之前的研究类似。诊断在住院期间根据有效标准确定。我们检查了患者延误情况，即从症状出现到呼叫救护车的时间、从呼叫到到达现场的时间以及从现场到到达医院的时间。在医院护理期间，我们检查了患者入院到血管开通的时间（门到针时间）。数据还按全国和各县进行了分类统计。结果：全国ST段抬高型心肌梗死患者的中位患者延误时间为140分钟（Q1：51；Q3：458）。中位救护车到达时间为13.2分钟（Q1：8.0；Q3：21.1），中位现场护理时间为25.5分钟（Q1：17.6；Q3：34.9），中位现场到医院时间为31.0分钟（Q1：19.5；Q3：43.7）。各县的到达时间范围为8.8 - 17.9分钟。全国ST段抬高型心肌梗死患者的中位门到针时间为51.5分钟（Q1：28.7；Q3：121.7）。在非ST段抬高型心肌梗死组中，中位患者延误时间为373分钟（Q1：106；Q3：1184），到达现场的时间为14.2分钟（Q1：8.5；Q3：24.8）。对于ST段抬高型心肌梗死，与上一时期相比患者延误时间增加了近40分钟（101对140分钟），救护车到达现场的中位时间（13.0对13.2分钟）没有显著变化。本研究中的门到针时间比以前长了近15分钟（37.0对51.5分钟）。在ST段抬高型心肌梗死组中，4.1%的患者在2小时内开通血管，38.3%的患者在4小时内开通血管。结论：就总缺血时间而言，患者延误是决定性因素，因此，在很大一部分治疗中，血运重建未在最佳时间进行。《匈牙利医学周报》。2025年；166(25):963 - 969。
