Timely Reperfusion in Stroke and Myocardial Infarction Is Not Correlated: An Opportunity for Better Coordination of Acute Care.
Timely Reperfusion in Stroke and Myocardial Infarction Is Not Correlated: An Opportunity for Better Coordination of Acute Care.
复制标题
中风和心肌梗死的及时再灌注并不相关：更好地协调急性护理的机会。
DOI：
10.1161/circoutcomes.116.003148
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发表时间：
2017
期刊：
影响因子：
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通讯作者：
Schwamm,LeeH
中科院分区：
文献类型：
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作者：
SauserZachrison,Kori;Levine,DeborahA;Fonarow,GreggC;Bhatt,DeepakL;Cox,Margueritte;Schulte,Phillip;Smith,EricE;Suter,RobertE;Xian,Ying;Schwamm,LeeH
研究背景及时再灌注是急性缺血性脑卒中（AIS）和ST段抬高型心肌梗死（STEMI）的关键。医院在急诊STEMI和AIS治疗方面的相关程度尚不清楚。本研究的主要目的是确定STEMI的入院至球囊（D2 B）时间与AIS的入院至穿刺（DTN）时间之间是否存在正相关性，方法和结果前瞻性研究的所有医院都在获得与指南中风和获得与指南-2006年至2009年的冠状动脉疾病，治疗≥10例患者。我们使用斯皮尔曼等级相关系数和分层线性回归模型比较了医院级别的DTN时间和D2 B时间。43家医院共收治AIS患者1976例，STEMI患者59823例。医院对AIS的DTN时间与STEMI的D2 B时间无关（ρ=-0.09;P=0.55）。在AIS和STEMI的目标时间窗内接受治疗的医院合格患者比例之间没有相关性（中位DTN时间<60分钟：21% [四分位距，11-30];中位D2 B时间<90分钟：68% [四分位距，62-79]; ρ=-0.14;P=0.36）。在风险调整后，医院的DTN和D2 B时间之间缺乏相关性。我们还使用Get With The Guidelines（DTN时间）和Hospital Compare（D2 B时间）将2013年至2014年的医院DTN时间和D2 B时间数据进行了关联。从2013年到2014年，医院的DTN时间性能与指南中的D2 B时间性能不相关，医院比较（n=546 hospitals）.ConclusionsWe发现医院的观察或风险调整后的DTN和D2 B时间之间没有相关性。有机会以协调的方式改善医院对AIS和STEMI的时间关键型护理流程的表现。
BackgroundTimely reperfusion is critical in acute ischemic stroke (AIS) and ST-segment–elevation myocardial infarction (STEMI). The degree to which hospital performance is correlated on emergent STEMI and AIS care is unknown. Primary objective of this study was to determine whether there was a positive correlation between hospital performance on door-to-balloon (D2B) time for STEMI and door-to-needle (DTN) time for AIS, with and without controlling for patient and hospital differences.Methods and ResultsProspective study of all hospitals in both Get With The Guidelines-Stroke and Get With The Guidelines-Coronary Artery Disease from 2006 to 2009 and treating ≥10 patients. We compared hospital-level DTN time and D2B time using Spearman rank correlation coefficients and hierarchical linear regression modeling. There were 43 hospitals with 1976 AIS and 59 823 STEMI patients. Hospitals’ DTN times for AIS did not correlate with D2B times for STEMI (ρ=−0.09;P=0.55). There was no correlation between hospitals’ proportion of eligible patients treated within target time windows for AIS and STEMI (median DTN time <60 minutes: 21% [interquartile range, 11–30]; median D2B time <90 minutes: 68% [interquartile range, 62–79]; ρ=−0.14;P=0.36). The lack of correlation between hospitals’ DTN and D2B times persisted after risk adjustment. We also correlated hospitals’ DTN time and D2B time data from 2013 to 2014 using Get With The Guidelines (DTN time) and Hospital Compare (D2B time). From 2013 to 2014, hospitals’ DTN time performance in Get With The Guidelines was not correlated with D2B time performance in Hospital Compare (n=546 hospitals).ConclusionsWe found no correlation between hospitals’ observed or risk-adjusted DTN and D2B times. Opportunities exist to improve hospitals’ performance of time-critical care processes for AIS and STEMI in a coordinated approach.