Primary angioplasty in Portugal: door-to-balloon time is not a good performance index.
Primary angioplasty in Portugal: door-to-balloon time is not a good performance index.
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DOI：
10.4244/eijv8spa21
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发表时间：
2012-08-01
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影响因子：
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通讯作者：
Pereira, Helder
中科院分区：
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作者：
Pereira, Helder
目标：尽管直接血管成形术是ST段抬高急性心肌梗死患者的推荐治疗方法，但最近的研究表明，在欧洲获得这种治疗形式存在很大的异质性。该项目“支架的生活”，欧洲心脏病学会的倡议，其中葡萄牙在2011年2月加入，旨在改善这种情况。方法和结果：本研究的目的是重新评估葡萄牙的基本性能指标为主要血管成形术。为此，开展了一项为期一个月的全国性调查，称为“零时刻”。十九个葡萄牙介入心脏病学中心，其中主要血管成形术进行，被邀请参加这项研究。从2011年5月9日至6月8日，14家中心参与了本研究，185例患者入组，平均年龄为62±14岁，其中76.8%为男性。17.5%的患者有糖尿病病史，8.4%的患者既往接受过经皮冠状动脉介入治疗，7.6%的患者发生过心肌梗死，1.1%的患者接受过冠状动脉搭桥手术。只有29%的患者使用单一的国家紧急医疗电话号码（112）寻求支持。中位患者延迟为120（73-240）分钟。院前运输系统延迟的中位数为104（73-240）分钟。中位门到球囊延迟（D2 B）为64（30-110）分钟，联系国家医疗急救研究所（INEM）的患者与未联系该服务的患者之间无显著差异：69（30-109）分钟vs 60（30-111）分钟。在56%的病例中，患者在转移到具有主要血管成形术设施的医院之前进入当地医院。入院到当地医院和入院到有介入心脏科的医院之间的时间为109（73-173）分钟。正如“零时刻”所揭示的那样，葡萄牙初次血管成形术方案取得更好效果的主要障碍是，联系INEM的患者人数较少，而在没有介入心脏病学单位的中心就诊的患者人数较多，导致在到具有这种服务的机构的二次运输中花费的长时间延迟。D2 B延迟虽然接近指南推荐的90分钟，但并不是葡萄牙初次血管成形术整体性能的良好指标。
AIMS: Despite primary angioplasty being the recommended treatment for patients with acute myocardial infarction with ST-elevation, recent studies have shown a great heterogeneity in the access to this form of treatment in Europe. The project "Stent for Life", an initiative of the European Society of Cardiology which Portugal joined in February 2011, aims to improve this situation.METHODS AND RESULTS: The objective of this study was to re-evaluate the basic Portuguese performance indicators for primary angioplasty. A national survey called "Moment Zero" was implemented for a one-month period for this purpose. Nineteen Portuguese centres of interventional cardiology, where primary angioplasty is carried out, were invited to participate in this study. From 9th May to 8th June 2011, 14 centres participated in this study and 185 patients were included with a mean age of 62±14 years, of which 76.8% were male. 17.5% of the patients presented with a medical history of diabetes mellitus, 8.4% had previous percutaneous coronary intervention, 7.6% myocardial infarction and 1.1% coronary artery bypass surgery. Only 29% of the patients used the single national number for medical emergencies (112) to call for support. The median patient delay was 120 (73-240) minutes. The median pre-hospital transportation system delay was 104 (73-240) minutes. The median door-to-balloon delay (D2B) was 64 (30-110) minutes and was not significantly different between patients who contacted the National Institute for Medical Emergency (INEM) and patients who did not contact this service: 69 (30-109) minutes versus 60 (30-111) minutes. In 56% of the cases, patients entered a local hospital before transferring to a hospital with primary angioplasty facilities. The time between the admission to the local hospital and admission to a hospital with an interventional cardiology unit was 109 (73-173) minutes.CONCLUSIONS: The main barriers to a better performance of the primary angioplasty programme in Portugal, as revealed by "Moment Zero", are the low number of patients who contacted the INEM and the high number of patients who attended centres without interventional cardiology units, resulting in long delays spent in secondary transportation to the institutions with such services. The D2B delay, although close to the 90 minutes recommended by the guidelines, is not a good indicator of the overall performance of primary angioplasty in Portugal.