• 作者：Oriol Rodrí ; guez-Leor^a ; ^{oriolrodriguez@gmail.com} ; Eduard Ferná ; ndez-Nofrerí ; as^a ; Fina Mauri^a ; Neus Salvatella^a ; Xavier Carrillo^a ; Antoni Curó ; s^a ; Jordi Serra^a ; Vicente Valle^a ; Antoni Bayes-Genis^a ; ^b
• 关键词：AP ; angioplastia primaria ; IAMCEST ; infarto agudo de miocardio con elevaci&oacute ; n del segmento ST ; PCM ; primer contacto mé ; dico ; SEM ; sistema de emergencias mé ; dicas ; TPR ; tiempo entre el primer contacto mé ; dico y la reperfusi&oacute ; n
• 刊名：Revista Espa帽ola de Cardiolog铆a
• 出版年：2011
• 期刊代码：pca308_03008932
• 类别：med
• 出版时间：June 2011
• 卷：64
• 期：6
• 页码：476-483
• 文件大小：220 K

Introduction and objectives

In primary angioplasty, the interval between first medical contact (FMC) and reperfusion should be less than 120 minutes. The time to reperfusion varies depending on where FMC is established. Recent studies suggest longer times in patients presenting in off-hours. The objective is to evaluate the time intervals between the onset of symptoms and reperfusion according to where the FMC occurs and time of day of patient presentation.

Methods

Prospective observational study of acute myocardial infarction patients treated with primary angioplasty (February 2007 to May 2009). Depending on the FMC, patients were classified as belonging to the hospital group (hospital with primary angioplasty), the transfer group (hospital without primary angioplasty), or the emergency medical system (EMS) group (out-of-hospital care). For each group, the prehospital delay, diagnostic delay, delay in activation and/or transfer, and procedure delay were recorded.

Results

Primary angioplasty was performed in 457 patients: 155 in the hospital group, 228 in the transfer group and 72 in the EMS group. The median [interquartile range] door-to-reperfusion times were 80 [63-107], 148 [118-189] and 81 [66-98] minutes, respectively (P < .0001). The transfer group showed a greater delay in diagnosis (P < .0001) and delayed activation and/or transfer (P < .0001). The EMS group had the shortest total time due to a reduced prehospital delay (P = .001). No difference was found with regard to the time of presentation (P = .42).

Conclusions

Transfer group patients were treated later and EMS group patients much earlier. There were no differences in association with the time of presentation. The identification of inappropriate delays should enable the introduction of measures to improve the efficiency of treatment.

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