转诊是接受急诊冠脉介入治疗ST段抬高型心肌梗死患者总缺血时间的独立预测因素

Transfer independently influences total ischemic time in primary percutaneous coronary intervention

目的:探讨影响接受急诊冠脉介入治疗的ST段抬高型心肌梗死患者总缺血时间的因素。方法:回顾性分析2009年1月至2012年12月在南京市鼓楼医院接受急诊冠脉介入治疗的ST段抬高型心肌梗死患者资料,共330例患者纳入研究,平均年龄64岁,其中男260例(78.8%),转诊患者157例(47.6%)。按照总缺血时间的百分位数将患者分为4组,比较每组间患者的基线资料、临床信息和缺血时间,通过多元回归分析找到总缺血时间的独立影响因素。结果:高中学历、医保、转诊、不典型胸痛、症状发作至我院时间、门-球囊时间和总缺血时间具有统计学差异,其中高中及以上学历和医保患者总缺血时间相对较短,而不典型胸痛患者的总缺血时间相对延长,但仅转诊是唯一独立影响总缺血时间的因素。结论:转诊导致较长的总缺血时间,主要是通过延长症状发作至医院就诊的时间实现的。

Objective To identify factors that cause longer ischemic time among ST segment elevation myocardial infarction patients. Methods ST segment elevation myocardial infarction patients who received primary percutaneous coronary intervention between January 2009 and December 2012 in Nanjing Drum-tower hospital were retrospectively studied. 330 patients （260 male patients, 157 referrals）, with an average age of 64 years, were selected as research subjects. Total ischemic time was estimated as the sum of pain onset to door time and door to balloon time. Patients were divided into four groups according to the quartiles of total ischemic time. Patients＇ demographic information, clinical information and total ischemic time were compared among the four groups. Multi-variable linear regression analysis was employed to reveal the independent influencing factors. Results There was difference in education level, medical insurance status, transferring from another hospital, atypical chest pain, pain onset to door time, door to balloon time and total ischemic time among the four groups. Education level and medical insurance status increase TIT while atypical chest pain decreases TIT. Transferring from another hospital was found to be the only independent influencing factor of total ischemic time. Conclusion Transferring from another hospital independently impacts total ischemic time, and increases total ischemic time mainly by prolonging pain onset to door time.