Pre-Hospital Triage for Primary Angioplasty Direct Referral to the Intervention Center Versus Interhospital Transport
Pre-Hospital Triage for Primary Angioplasty Direct Referral to the Intervention Center Versus Interhospital Transport
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DOI：
10.1016/j.jcin.2010.04.010
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发表时间：
2010-07-01
影响因子：
11.3
通讯作者：
Verheugt, Freek W. A.
中科院分区：
文献类型：
--
作者：
Dieker, Hendrik-Jan;Liem, Stephan S. B.;Verheugt, Freek W. A.
目的研究院前诊断为st段抬高型心肌梗死（STEMI）后直接转诊到干预中心对治疗间隔时间和预后的影响。背景：原发性血管成形术已成为STEMI患者首选的再灌注策略。救护车诊断和直接转介到干预中心是一种有吸引力的治疗选择，尚未广泛研究。连续的方法。我们研究了2005年至2007年间转介到我们干预中心进行初级血管成形术的院前STEM患者。院前诊断后，患者要么直接被送到我们的中心，要么通过非干预中心转诊。导管实验室在运送到干预中心之前被激活。结果在581例患者中，454例（78%）采用直接交通方式，127例（22%）通过非干预中心。直接运输与STEMI指南90分钟时间窗内接受治疗的患者比例较高相关：82%对23% （p < 0.01）。直接转运的患者从症状到球囊的中位时间明显缩短，为149分钟（四分位数范围：118至197分钟），而219分钟（四分位数范围：178至315分钟），p < 0.01，术后心肌梗死溶栓（TIMI）血流3级率较高（92%对84%，p = 0.03）， 1年死亡率较低（7%对13%，p = 0.03）。直接转运到干预中心与症状到气囊时间独立相关，这反过来又是术后TIMI血流3级的独立预测因子，是预后的有力预测因子。结论在基于救护车的STEMI诊断后，直接转运至干预中心并在院前通知导管室的患者在指南时间窗内接受治疗的比例增加了三倍以上。气囊时间是术后TIMI血流3级的独立预测指标，这强调了减少治疗延误的必要性。[J] journal of Cardiology; 2010;3:705-11] (c) 2010
Objectives We sought to study the impact of direct referral to an intervention center after pre-hospital diagnosis of ST-segment elevation myocardial infarction (STEMI) on treatment intervals and outcome.Background Primary angioplasty has become the preferred reperfusion strategy in STEMI. Ambulance diagnosis and direct referral to an intervention center is an attractive treatment option that has not been studied extensively.Methods Consecutive. pre-hospital patients with STEM, who were referred to our intervention center for primary angioplasty between 2005 and 2007, were studied. After pre-hospital diagnosis, patients were either directly transported to our center or referred through a nonintervention center. The catheterization laboratory was activated before transport to the intervention center.Results Of the 581 patients referred, 454 (78%) came with direct transport and 127 (22%) through a nonintervention center. Direct transport was associated with a higher proportion of patients treated within the 90-min time window of the STEMI guidelines: 82% versus 23% (p < 0.01). Patients directly transported had a significantly shorter median symptom-to-balloon time of 149 min (Interquartile range: 118 to 197 min) versus 219 min, (interquartile range: 178 to 315 min), p < 0.01, a higher post-procedural Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 rate (92% vs. 84%; p = 0.03), and a lower 1-year mortality rate (7% vs. 13%; p = 0.03). Direct transport to the intervention center was independently associated with the symptom-to-balloon time, which in turn was an independent predictor of post-procedural TIMI flow grade 3, a strong prognosticator of outcome.Conclusions After ambulance-based diagnosis of STEMI, direct transport to an intervention center with pre-hospital notification of the catheterization laboratory more than triples the proportion of patients treated within the time window of the guidelines. Time to balloon was an independent predictor of post-procedural TIMI flow grade 3, which underscores the need to reduce treatment delays. (J Am Coll Cardiol Intv 2010;3:705-11) (c) 2010 by the American College of Cardiology Foundation