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首页> 外文期刊>Circulation: An Official Journal of the American Heart Association >The impact of a statewide pre-hospital STEMI strategy to bypass hospitals without percutaneous coronary intervention capability on treatment times
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The impact of a statewide pre-hospital STEMI strategy to bypass hospitals without percutaneous coronary intervention capability on treatment times

机译：州所有医院的影响造成医院的治疗时间没有经皮冠状动脉干预能力

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摘要

BACKGROUND-: The ultimate treatment goal for ST-segment elevation myocardial infarction (STEMI) is rapid reperfusion via primary percutaneous intervention (PCI). North Carolina has adopted a statewide STEMI referral strategy that advises paramedics to bypass local hospitals and transport STEMI patients directly to a PCI-capable hospital, even if a non-PCI-capable hospital is closer. METHODS AND RESULTS-: We assessed the adherence of emergency medical services to this STEMI protocol, as well as subsequent associations with patient treatment times and outcomes by linking data from the Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines and a statewide emergency medical services data system from June 2008 to September 2010 for all patients with STEMI. Patients were divided into those (1) transported directly to a PCI hospital, thereby bypassing a closer non-PCI hospital and (2) first taken to a closer non-PCI center and later transferred to a PCI hospital. Among 6010 patients with STEMI, 1288 were eligible and included in our study cohort. Of these, 826 (64%) were transported directly to a PCI facility, whereas 462 (36%) were first taken to a non-PCI hospital and later transferred. In a multivariable model, increase in differential driving time and cardiac arrest were associated with a lesser likelihood of being taken directly to a PCI center, whereas a history of PCI was associated with a higher likelihood of being taken directly to a PCI center. Patients sent directly to a PCI center were more likely to have times between first medical contact and PCI within guideline recommendations. CONCLUSIONS-: We found that patients who were sent directly to a PCI center had significantly shorter time to reperfusion. ? 2012 American Heart Association, Inc.
机译：背景 - ST段升高的最终治疗目标是通过初级经皮干预（PCI）快速再灌注。北卡罗来纳州采用了全国主义的STEMI推荐战略，即使非PCI的医院更接近，也通过了绕过医护人员绕过PCI的医院绕过PCI的医院。方法和结果 - ：我们评估了应急医疗服务对该STEMI议定书的依从，以及通过将数据与急性冠状动脉治疗和干预的数据联系起来，随后与患者治疗时间和结果进行后续缔约国登记处与指南和全州一起联系起来紧急医疗服务数据系统从2008年6月到2010年9月，所有Stemi患者。将患者分为直接向PCI医院运输的那些（1），从而绕过更接近的非PCI医院和（2）首先被送到更近的非PCI中心，后来转移到PCI医院。在6010名Stemi，1288名患者中符合条件并包含在我们的研究队列中。其中，将826％（64％）直接运输到PCI设施，而462（36％）首先被送到非PCI医院，后来转移。在多变量的模型中，差分驾驶时间和心脏骤停的增加与直接拍摄到PCI中心的较小可能性相关，而PCI的历史与直接拍摄到PCI中心的较高可能性相关联。直接发送给PCI中心的患者更有可能在指导建议中有第一次医学联系和PCI之间的时间。结论 - ：我们发现直接发送给PCI中心的患者在再灌注时显着缩短了较短的时间。还2012年美国心脏协会，Inc。

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    FosbolE.L.; GrangerC.B.; JollisJ.G.; MonkL.; LinL.; LytleB.L.; XianY.; GarveyJ.L.; MearsG.; CorbettC.C.; PetersonE.D.; GlickmanS.W.;

  • 作者单位

    Duke Clinical Research Institute Duke University Medical Center 2400 Pratt Street Durham NC;

    Duke Clinical Research Institute Duke University Medical Center 2400 Pratt Street Durham NC;

    Duke Clinical Research Institute Duke University Medical Center 2400 Pratt Street Durham NC;

    Duke Clinical Research Institute Duke University Medical Center 2400 Pratt Street Durham NC;

    Duke Clinical Research Institute Duke University Medical Center 2400 Pratt Street Durham NC;

    Duke Clinical Research Institute Duke University Medical Center 2400 Pratt Street Durham NC;

    Duke Clinical Research Institute Duke University Medical Center 2400 Pratt Street Durham NC;

    Department of Emergency Medicine Carolinas Medical Center Charlotte NC United States;

    Department of Emergency Medicine University of North Carolina at Chapel Hill Chapel Hill NC;

    New Hanover Regional Medical Center Wilmington NC United States;

    Duke Clinical Research Institute Duke University Medical Center 2400 Pratt Street Durham NC;

    Duke Clinical Research Institute Duke University Medical Center 2400 Pratt Street Durham NC;

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  • 正文语种 eng
  • 中图分类 心脏、血管（循环系）疾病;
  • 关键词

    EMS transport; reperfusion time; STEMI;

    机译：EMS运输;再灌注时间;Stemi;

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