林吉怡,欧尾妹,黄薇薇,王焱,林绍清,陈媛,王斌

• 1:厦门大学附属心血管病医院急诊科
• 2:厦门市胸痛质量控制中心
• 3:厦门大学附属心血管病医院运营管理部
• 4:厦门大学附属心血管病医院心内科

摘要(Abstract)：

目的 探讨不同来院方式对急性ST段抬高型心肌梗死（STEMI）患者的再灌注时间及短期预后的影响。方法 纳入2023年1月至2024年11月在厦门大学附属心血管病医院胸痛中心就诊并被诊断为STEMI的患者497例，所有患者均接受直接经皮冠状动脉介入治疗。根据来院方式不同将患者分为自行来院组（122例）、“120”转运组（51例）和网络医院转诊组（324例）。比较3组患者的基本特征、再灌注时间和住院期间并发症。结果 497例STEMI患者年龄（58.64±13.62）岁，男423例（85.11%）。与自行来院组、“120”转运组相比，网络医院转诊组的入门至导丝通过时间更短[35(29,45)min比43(35,53)min比43(33,48)min,P<0.001]，但首次医疗接触至导丝通过时间更长[123(80,192)min比43(35,52)min比57(51,76)min,P<0.001]，差异均有统计学意义。与自行来院组、网络医院转诊组相比，“120”转运组的发病至首次医疗接触时间[55(32,136)min比185(116,360)min比120(60,236)min,P<0.001]和发病至导丝通过时间[136(101,188)min比228(169,413)min比282(190,400)min,P<0.001]更短，差异均有统计学意义。网络医院转诊组的院内感染发生率低于自行来院组（12.65%比22.95%,P<0.05）。结论 为全面提升救治效果，应优先推广并持续优化“120”响应流程，同步强化网络医院转诊标准化协作，并通过公众宣教增强STEMI识别能力，减少自行来院延误。

关键词(KeyWords)： 心肌梗死;来院方式;再灌注时间;短期预后;胸痛中心

Abstract:

Keywords:

基金项目(Foundation): 厦门市科技计划项目(3502Z20224008);; 厦门市自然科学基金项目(3502Z202371050)

作者(Author): 林吉怡,欧尾妹,黄薇薇,王焱,林绍清,陈媛,王斌

参考文献(References)：

• [1]刘明波，何新叶，杨晓红，等.《中国心血管健康与疾病报告2023》概要（心血管疾病流行及介入诊疗状况）[J].中国介入心脏病学杂志，2024,32(10):541-550. DOI:10.3969/j. issn.1004-8812.2024.10.001.
• [2] Lawton JS,Tamis-Holland JE,Bangalore S,et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization:a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines[J]. J Am Coll Cardiol,2022,79(2):e21-e129.DOI:10.1016/j.jacc.2021.09.006.
• [3]急性ST段抬高型心肌梗死诊断和治疗指南（2019）[J].中华心血管病杂志，2019,47(10):766-783. DOI:10.3760/cma.j.issn.0253-3758.2019.10.003.
• [4]国家心血管系统疾病医疗质量控制中心. 2023年中国心血管病医疗质量概述[J].中国循环杂志，2024,39(9):833-852. DOI:10.3969/j.issn.1000-3614.2024.09.001.
• [5] Ibanez B,James S,Agewall S,et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation:the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology(ESC)[J]. Eur Heart J,2018,39(2):119-177. DOI:10.1093/eurheartj/ehx393.
• [6]苏州工业园区东方华夏心血管健康研究院，国家放射与治疗临床医学研究中心胸痛中心专家委员会.《胸痛中心质控报告（2023）》概要[J].中国介入心脏病学杂志，2024,32(11):618-625. DOI:10.3969/j.issn.1004-8812.2024.11.002.
• [7]易绍东，向定成，段天兵，等．建立胸痛中心对不同来院方式ST段抬高急性心肌梗死患者进门-球囊时间的影响[J].中国介入心脏病学杂志，2014,22(9):549-552. DOI:10.3969/j.issn.1004-8812.2014.09.002.
• [8]林全洪，许向东，张云柯，等.不同来院方式急性ST段抬高心肌梗死患者再灌注时间与结果影响因素分析[J].中华急诊医学杂志，2020,29(7):921-928. DOI:10.3760/cma.j.issn.1671-0282.2020.07.006.
• [9] Wang Q,Zan C,Li F,et al. The impact of admission modes on the treatment outcome and in-hospital mortality rate of STEMI patients undergoing PPCI[J]. Sci Rep,2024,14(1):18932. DOI:10.1038/s41598-024-68025-2.
• [10] de Diego O,Rueda F,Carrillo X,et al. Performance analysis of a STEMI network:prognostic impact of the type of fi rst medical contact facility[J]. Rev Esp Cardiol(Engl Ed),2023,76(9):708-718. DOI:10.1016/j.rec.2022.12.010.
• [11] Byrne RA,Rossello X,Coughlan JJ,et al. 2023 ESC Guidelines for the management of acute coronary syndromes[J]. Eur Heart J Acute Cardiovasc Care,2024,13(1):55-161. DOI:10.1093/ehjacc/zuad107.
• [12] Mathews R,Peterson ED,Li S,et al. Use of emergency medical service transport among patients with ST-segment-elevation myocardial infarction：fi ndings from the National Cardiovascular Data Registry Acute Coronary Treatment Intervention Outcomes Network Registryget with the guidelines[J]. Circulation,2011,124(2):154-163. DOI:10.1161/CIRCULATIONAHA.110.002345.
• [13] Mooney M,O'Brien F,McKee G,et al. Ambulance use in acute coronary syndrome in Ireland:a cross-sectional study[J]. Eur J Cardiovasc Nurs,2016,15(5):345-354.DOI:10.1177/1474515115579134.
• [14]王凤华，魏茂提，徐宁，等.不同来院方式急性ST段抬高心肌梗死患者再灌注时间及院内死亡危险因素分析[J].临床心血管病杂志，2022,38(4):298-303. DOI:10.13201/j.issn.1001-1439.2022.04.009.
• [15] He C,Zhang Y,Tang M,et al. Analysis of barriers associated with emergency medical service activation in patients with acute stroke and acute myocardial infarction from Zhongjiang County of Sichuan Province in China[J]. BMC Emerg Med,2024,24(1):113. DOI:10.1186/s12873-024-01035-5.
• [16] Dharma S,Dakota I,Andriantoro H,et al. Interhospital transfer versus direct admission in patients with acute ST-segment elevation myocardial infarction[J]. Int J Angiol,2020,32(2):121-127. DOI:10.1055/s-0040-1714686.
• [17] Kawecki D,Gierlotka M,Morawiec B,et al. Direct Admission versus interhospital transfer for primary percutaneous coronary intervention in ST-segment elevation myocardial infarction[J]. JACC Cardiovasc Interv,2017,10(5):438-447. DOI:10.1016/j.jcin.2016.11.028.
• [18] Dakota I,Dharma S,Andriantoro H,et al.“Door-in to doorout”delay in patients with acute ST-segment elevation myocardial infarction transferred for primary percutaneous coronary intervention in a metropolitan STEMI network of a developing country[J]. Int J Angiol,2020,29(1):27-32. DOI:10.1055/s-0039-3401046.
• [19] Lambert LJ,Brown KA,Boothroyd LJ,et al. Transfer of patients with ST-elevation myocardial infarction for primary percutaneous coronary intervention:a province-wide evaluation of"door-in to door-out"delays at the fi rst hospital[J]. Circulation,2014,129(25):2653-2660.DOI:10.1161/CIRCULATIONAHA.113.007130.
• [20]陈国钦，张稳柱，李健豪，等．胸痛中心模式下不同到院方式对急性ST段抬高型心肌梗死患者再灌注时间的影响[J]．中国循环杂志，2017,32(9):859-863.DOI:10.3969/j.issn.1000-3614.2017.09.007.
• [21]陈伟杰，杨智华，石燕昆，等．区域协同救治模式下转运距离对ST段抬高型心肌梗死患者溶栓治疗后或直接转运经皮冠状动脉介入治疗预后的影响[J].中国介入心脏病学杂志，2022,30(12):890-897. DOI:10.3969/j.issn.1004-8812.2022.12.002.
• [22]江苏省医学会心血管病学分会，江苏省医师协会心血管内科医师分会，江苏省医师协会心脏重症专业委员会，等.急性ST段抬高型心肌梗死溶栓治疗专家共识[J].中国介入心脏病学杂志，2024,32(7):364-382. DOI:10.3969/j.issn.1004-8812.2024.07.002.
• [23] Koul S,Andell P,Martinsson A,et al. Delay from fi rst medical contact to primary PCI and all-cause mortality:a nationwide study of patients with ST-elevation myocardial infarction[J]. J Am Heart Assoc,2014,3(2):e000486. DOI:10.1161/JAHA.113.000486.
• [24] Putot A,Chague F,Manckoundia P,et al. Post-infectious myocardial infarction:new insights for improved screening[J]. J Clin Med,2019,8(6):827. DOI:10.3390/jcm8060827.
• [25] Almendro-Delia M,Hernández-Meneses B,Padilla-Rodríguez G,et al. Timing of P2Y12 inhibitor administration in patients with STEMI undergoing primary PCI[J]. J Am Coll Cardiol,2024,83(25):2629-2639. DOI:10.1016/j.jacc.2024.04.036.
• [26] Kawecki D,Gierlotka M,Morawiec B,et al. Direct admission versus interhospital transfer for primary percutaneous coronary intervention in ST-segment elevation myocardial infarction[J].JACC Cardiovasc Interv,2017,10(5):438-447. DOI:10.1016/j.jcin.2016.11.028.