The pre-hospital electrocardiogram and time to reperfusion in patients with acute myocardial infarction, 2000-2002 - Findings from the National Registry of Myocardial Infarction-4
The pre-hospital electrocardiogram and time to reperfusion in patients with acute myocardial infarction, 2000-2002 - Findings from the National Registry of Myocardial Infarction-4
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DOI：
10.1016/j.jacc.2005.10.077
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发表时间：
2006-04-18
影响因子：
24
通讯作者：
Krumholz, HM
中科院分区：
文献类型：
--
作者：
Curtis, JP;Portnay, EL;Krumholz, HM
目的探讨院前心电图在ST段抬高型心肌梗死(STEMI)再通治疗中的应用，评价院前心电图对门到再灌注时间的影响。背景：虽然国家指南推荐使用院前心电图，但目前有关其使用和有效性的信息有限。方法采用美国国家心肌梗死登记处的数据，我们研究了STEMI或左束支传导阻滞患者入院6h内接受溶栓治疗(n=35,370)或直接经皮冠状动脉介入治疗(n=21,277)的急性再灌注。我们确定了院前心电图的使用率，评估了院前心电图与门到再灌注时间的相关性，并使用分层模型调整患者和医院特征的差异来估计再通时间的增量减少。结果在4.5%的纤溶治疗队列和8.0%的经皮冠状动脉介入治疗队列中进行了院前心电图检查。在调整了患者和医院的特征后，院前心电的使用与几何平均门到药时间显著缩短相关：24.6min(95%可信区间：23.7至25.5)比34.7min(95%CI：34.2至35.3p<；0.0001)，几何平均门至球囊时间显著缩短(94.0min[95%CI：91.8至96.3]vs 110.3分钟[95%CI：108.7至112.0]；P<；0.0001)。结论全国使用院前心电图诊断和辅助治疗STEMI的比例仍然很低。然而，当使用时，院前心电图与显著缩短的再通时间相关。
OBJECTIVES The aim of this study was to determine the use of pre-hospital electrocardiogram (ECG) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing reperfusion therapy, and evaluate the effect of pre-hospital ECG on door-to-reperfusion times.BACKGROUND Although national guidelines recommend the use of pre-hospital ECG, there is limited contemporary information about its current use and effectiveness.METHODS Using data from the National Registry of Myocardial Infarction-4, we studied patients with STEMI or left bundle branch block who received acute reperfusion with either fibrinolytic therapy (n = 35,370) or primary percutaneous coronary intervention (PCI) (n = 21,277) within 6 h of admission. We determined the prevalence of pre-hospital ECG use, evaluated the association between pre-hospital ECG and door-to-reperfusion time, and estimated the incremental reduction in time to reperfusion using hierarchical models to adjust for differences in patient and hospital characteristics.RESULTS A pre-hospital ECG was performed in 4.5% of the fibrinolytic therapy cohort and in 8.0% of the PCI cohort. After adjusting for patient and hospital characteristics, the use of pre-hospital ECG was associated with a significantly shorter geometric mean door-to-drug time: 24.6 min (95% confidence interval [CI]: 23.7 to 25.5) vs. 34.7 min (95% CI: 34.2 to 35.3; p < 0.0001), and a significantly shorter geometric mean door-to-balloon time (94.0 min [95% CI: 91.8 to 96.3] vs. 110.3 min [95% CI: 108.7 to 112.0]; p < 0.0001).CONCLUSIONS The national use of pre-hospital ECG to diagnose and facilitate the treatment of STEMI remains low. When used, however, pre-hospital ECG is associated with a significantly shorter time to reperfusion.