Background

How quickly percutaneous coronary intervention is performed in patients with ST-elevation myocardial infarction (STEMI) is a quality measure, reported as door-to-balloon (D2B) time.

Objectives

To explore factors affecting STEMI performance in six hospitals in one healthcare system.

Methods

This was a retrospective chart review of clinical features and D2B times. Predictors for D2B times were identified using multivariate linear regression.

Results

The median D2B time for all six hospitals was 63 minutes and all hospitals surpassed the minimal recommended percentage of patients achieving D2B time ≤90 minutes (87.8%vs75%,p<0.001). Patient confounders adversely affect D2B times (+21.5 minutes, p<0.001). Field ECG/activation with emergency department (ED) transport (-22.0 minutes) or direct cardiac catheterization laboratory (CCL) transport (-27.3 minutes) was superior to ED ECG/activation (p<0.001).

Conclusion

Field ECG/STEMI activation significantly shortened D2B time. To improve D2B time, hospital and Emergency Medical Service collaboration should be advocated to increase field activation and direct patient transportation to CCL.

中文翻译：

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影响一个医疗保健系统内六家医院 STEMI 绩效的因素

背景

对 ST 段抬高型心肌梗死 (STEMI) 患者进行经皮冠状动脉介入治疗的速度有多快是一项质量指标，报告为入院至球囊 (D2B) 时间。

目标

探讨影响一个医疗保健系统中六家医院 STEMI 绩效的因素。

方法

这是对临床特征和 D2B 时间的回顾性图表审查。使用多元线性回归确定 D2B 时间的预测因子。

结果

所有六家医院的 D2B 时间中位数为 63 分钟，所有医院都超过了达到 D2B 时间≤90 分钟的最低推荐患者百分比（87.8% 对 75%，p<0.001）。患者混杂因素对 D2B 时间产生不利影响（+21.5 分钟，p<0.001）。急诊科 (ED) 转运（-22.0 分钟）或直接心导管实验室 (CCL) 转运（-27.3 分钟）的场心电图/激活优于急诊心电图/激活 (p<0.001)。

结论

现场 ECG/STEMI 激活显着缩短了 D2B 时间。为了缩短 D2B 时间，应提倡医院和紧急医疗服务合作，以增加现场激活和直接将患者运送到 CCL。