A regional system to provide timely access to percutaneous coronary intervention for ST-elevation myocardial infarction
A regional system to provide timely access to percutaneous coronary intervention for ST-elevation myocardial infarction
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DOI：
10.1161/circulationaha.107.694141
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发表时间：
2007-08-14
期刊：
影响因子：
37.8
通讯作者：
Larson, David M.
中科院分区：
文献类型：
--
作者：
Henry, Timothy D.;Sharkey, Scott W.;Larson, David M.
背景-在高容量中心及时进行经皮冠状动脉介入治疗ST段抬高型心肌梗死（STEMI）上级纤溶治疗。最近的欧洲试验表明，转经皮冠状动脉介入治疗也可能优于纤维蛋白溶解并增加经皮冠状动脉介入治疗的机会。上级。在美国，转移时间持续较长;因此，许多人认为ST段抬高型心肌梗死患者的PCI转移策略不切实际。方法和结果-我们为距离PCI中心210英里的30家医院的STEMI患者开发了一个标准化的基于PCI的治疗系统。从2003年3月至2006年11月，1345名连续的STEMI患者接受了治疗，其中1048名患者是非PCI医院转来的。距离PCI中心< 60英里（1区）和60至210英里（2区）的患者的第一次门到球囊的时间中位数分别为95分钟（第25和第75次门，82和116分钟）和120分钟（第25和第75次门，100和145分钟）。尽管高风险的糖尿病患者群体（心源性休克12.3%，心脏骤停10.8%，和老年人[ >= 80岁]，14.6%），住院死亡率为4.2%，中位住院时间为3天。结论-使用带有集成转运系统的标准化方案，将STEMI患者从社区医院快速转运至距离PCI中心210英里的地方是安全可行的。
Background - Percutaneous coronary intervention ( PCI) for ST- elevation myocardial infarction ( STEMI) is superior to fibrinolysis when performed in a timely manner in high- volume centers. Recent European trials suggest that transfer for PCI also may be superior to fibrinolysis and increase access to PCI. In the United States, transfer times are consistently long; therefore, many believe a transfer for PCI strategy for STEMI is not practical. Methods andResults - We developed a standardized PCI- based treatment system for STEMI patients from 30 hospitals up to 210 miles from a PCI center. From March 2003 to November 2006, 1345 consecutive STEMI patients were treated, including 1048 patients transferred from non- PCI hospitals. The median first door- to- balloon time for patients < 60 miles ( zone 1) and 60 to 210 miles ( zone 2) from the PCI center was 95 minutes ( 25th and 75th percentiles, 82 and 116 minutes) and 120 minutes ( 25th and 75th percentiles, 100 and 145 minutes), respectively. Despite the high- risk unselected patient population ( cardiogenic shock, 12.3%; cardiac arrest, 10.8%; and elderly [ >= 80 years of age], 14.6%), in- hospital mortality was 4.2%, and median length of stay was 3 days.Conclusions - Rapid transfer of STEMI patients from community hospitals up to 210 miles from a PCI center is safe and feasible using a standardized protocol with an integrated transfer system.