Objective To investigate whether admission time was associated with the delay of reperfusion therapy and in-hospital death in patients with ST-elevation myocardial infarction （STEMI）. Methods All patients with STEMI...Objective To investigate whether admission time was associated with the delay of reperfusion therapy and in-hospital death in patients with ST-elevation myocardial infarction （STEMI）. Methods All patients with STEMI who were admitted to the emergency depart- ment and underwent primary percutaneous coronary intervention at Peking University People＇s Hospital between April 2012 and March 2015 were included. We examined differences in clinical characteristics, total ischemic time, and in-hospital death between patients admitted during off-hours and those admitted during regular hours. Multivariate logistic regression was used to estimate the relationship between off-hours admission and clinical outcome. Results The sample comprised 184 and 105 patients with STEMI admitted to hospital during off-hours and regular hours, respectively. Total ischemic and onset-to-door times were significantly shorter in patients admitted during off-hours than among those admitted during regular hours （all P 〈 0.05）. Door-to-balloon （DTB） time, the rate of DTB time 〈 90 min, and in-hospital death were comparable between groups. Multivariate logistic regression showed that age and creatinine level, but not off-hours admission, were associated independently with increased in-hospital death. Conclusions Off-hours admission did not result in delayed reperfusion therapy or increased in-hospital mortality in patients with STEMI. Further efforts should focus on identifying pivotal factors associated with the pre-hospital and in-hospital delay of reperfusion therapy, and implementing quality improvement initiatives for reperfusion programs.展开更多
Background:It remains unclear whether the outcomes of ST-elevation myocardial infarction(STEMI)patients treated with primary percutaneous coronary intervention(PPCI)during off-hours are as favorable as those treated d...Background:It remains unclear whether the outcomes of ST-elevation myocardial infarction(STEMI)patients treated with primary percutaneous coronary intervention(PPCI)during off-hours are as favorable as those treated during on-hours,especially those with a first medical contact-to-device(FMC-to-device)time within 90 min.We aimed to determine whether off-hours admission impacted late outcomes in patients undergoing PPCI and with an FMC-to-device time<90 min.Methods:This multicenter retrospective study included 670 STEMI patients who underwent successful PPCI and had an FMC-to-device time<90 min from 19 chest pain centers in Beijing from January 2018 to December 2018.Patients were divided into on-hours group and off-hours group based on their arrival time.Baseline characteristics,clinical data,and key time intervals during treatment were collected from the Quality Control&Improvement Center of Cardiovascular Intervention of Beijing by the 4tHeart and Brain Green Channel”app.Results:Overall,the median age of the patients was 58.8 years and 19.9%(133/670)were female.Of these,296(44.2%)patients underwent PPCI during on-hours and 374(55.8%)patients underwent PPCI during off-hours.Compared with the on-hours group,the off-hours group had a longer FMC-to-device time and fewer patients with FMC-to-device time<60 min(P<0.05).During the mean follow-up period of 24 months,a total of 64(9.6%)participants experienced a major adverse cardiovascular event(MACE),with 28(9.1%)in the on-hours group and 36(9.6%)in the off-hours group(P>0.05).According to the Cox regression analyses,off-hours admission was not a predictor of 2-year MACEs(P=0.788).Similarly,the Kaplan-Meier curves showed that the risks of a MACE,all-cause death,reinfarction,and target vessel revascularization were not significantly different between the two groups(P>0.05).Conclusions:This real-world,multicenter retrospective study demonstrated that for STEMI patients who underwent PPCI within 90 min,off-hours admission was safe,with no difference in the risk of 2-year展开更多
文摘Objective To investigate whether admission time was associated with the delay of reperfusion therapy and in-hospital death in patients with ST-elevation myocardial infarction （STEMI）. Methods All patients with STEMI who were admitted to the emergency depart- ment and underwent primary percutaneous coronary intervention at Peking University People＇s Hospital between April 2012 and March 2015 were included. We examined differences in clinical characteristics, total ischemic time, and in-hospital death between patients admitted during off-hours and those admitted during regular hours. Multivariate logistic regression was used to estimate the relationship between off-hours admission and clinical outcome. Results The sample comprised 184 and 105 patients with STEMI admitted to hospital during off-hours and regular hours, respectively. Total ischemic and onset-to-door times were significantly shorter in patients admitted during off-hours than among those admitted during regular hours （all P 〈 0.05）. Door-to-balloon （DTB） time, the rate of DTB time 〈 90 min, and in-hospital death were comparable between groups. Multivariate logistic regression showed that age and creatinine level, but not off-hours admission, were associated independently with increased in-hospital death. Conclusions Off-hours admission did not result in delayed reperfusion therapy or increased in-hospital mortality in patients with STEMI. Further efforts should focus on identifying pivotal factors associated with the pre-hospital and in-hospital delay of reperfusion therapy, and implementing quality improvement initiatives for reperfusion programs.
基金a grant from the National Natural Science Foundation of China(No.81670415).
文摘Background:It remains unclear whether the outcomes of ST-elevation myocardial infarction(STEMI)patients treated with primary percutaneous coronary intervention(PPCI)during off-hours are as favorable as those treated during on-hours,especially those with a first medical contact-to-device(FMC-to-device)time within 90 min.We aimed to determine whether off-hours admission impacted late outcomes in patients undergoing PPCI and with an FMC-to-device time<90 min.Methods:This multicenter retrospective study included 670 STEMI patients who underwent successful PPCI and had an FMC-to-device time<90 min from 19 chest pain centers in Beijing from January 2018 to December 2018.Patients were divided into on-hours group and off-hours group based on their arrival time.Baseline characteristics,clinical data,and key time intervals during treatment were collected from the Quality Control&Improvement Center of Cardiovascular Intervention of Beijing by the 4tHeart and Brain Green Channel”app.Results:Overall,the median age of the patients was 58.8 years and 19.9%(133/670)were female.Of these,296(44.2%)patients underwent PPCI during on-hours and 374(55.8%)patients underwent PPCI during off-hours.Compared with the on-hours group,the off-hours group had a longer FMC-to-device time and fewer patients with FMC-to-device time<60 min(P<0.05).During the mean follow-up period of 24 months,a total of 64(9.6%)participants experienced a major adverse cardiovascular event(MACE),with 28(9.1%)in the on-hours group and 36(9.6%)in the off-hours group(P>0.05).According to the Cox regression analyses,off-hours admission was not a predictor of 2-year MACEs(P=0.788).Similarly,the Kaplan-Meier curves showed that the risks of a MACE,all-cause death,reinfarction,and target vessel revascularization were not significantly different between the two groups(P>0.05).Conclusions:This real-world,multicenter retrospective study demonstrated that for STEMI patients who underwent PPCI within 90 min,off-hours admission was safe,with no difference in the risk of 2-year
文摘目的 探究急性缺血性卒中(acute ischemic stroke, AIS)患者急诊到院后的血管内治疗(endovascular treatment, EVT)流程是否存在非工作时间效应。方法 回顾性分析2019年9月—2023年8月于四川大学华西医院脑卒中绿色通道入院拟行急诊EVT的AIS患者,根据到院时间将患者分为工作时间组与非工作时间组,对两组患者的临床信息、到院至行股动脉穿刺时间(door-to-puncture time, DPT)、到院至行头颈部影像学检查时间(door-to-head/neck imaging time, DIT)以及到院至行血液学检查时间(door-to-blood test time, DBT)进行比较,根据是否夜间到院、指南更新前后以及是否处于新型冠状病毒感染疫情时期进行亚组分析。结果 共纳入586例大血管闭塞型AIS患者,工作时间到院的患者220例,非工作时间到院的患者366例。工作时间到院与非工作时间到院患者的基本情况和EVT流程时间差异均无统计学意义(P>0.05)。亚组分析显示,非工作时间组中,夜间到院与非夜间到院患者的基本情况和EVT流程时间差异均无统计学意义(P>0.05)。指南更新前和指南更新后,工作时间到院与非工作时间到院患者的基本情况和EVT流程时间差异均无统计学意义(P>0.05)。新冠疫情时期和非新冠疫情时期,工作时间到院与非工作时间到院患者的基本情况和EVT流程时间差异均无统计学意义(P>0.05)。结论 AIS患者到院后EVT流程时间不存在非工作时间效应。未来需要更多不同级别的卒中中心进一步探索非工作时间效应对AIS患者急诊诊治的影响。
文摘目的探讨非工作时间就诊对于急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STE⁃MI)患者接受经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)及院内病死率的影响。方法选取2017年1~12月北京清华长庚医院124例接受PCI治疗的急性STEMI患者,分别记录人口统计学资料、实验室检查和临床资料,以就诊时间分为工作时间组(就诊时间为工作日08:00至17:00)及非工作时间组(就诊时间为工作日17:00至次日08:00,周末和节假日),分析两组患者间心电图完成时间、心脏损伤标志物完成时间、门到球囊时间(door-to-balloon time,D to B时间)、急诊滞留时间及院内病死率。采用单因素logistic回归分析观察指标与就诊时间的关系。结果工作时间就诊47例(37.9%),非工作时间就诊77例(62.1%),冠脉造影结果显示两组的犯罪血管均主要为左前降支。非工作时间组在心电图完成时间([8.73±10.05)min比(7.53±6.87)min,P=0.47]、心肌特异性肌钙蛋白(cardiac isoform of Tropnin T,cTnT)完成时间([37.53±15.54)min比(33.13±14.89)min,P=0.12],D to B时间([90.19±37.43)min比(95.34±59.25)min,P=0.55]和急诊滞留时间([51.66±32.21)min比(54.04±54.73)min,P=0.76]方面与工作时间组比较,差异均无统计学意义。将所有基线数据及D to B时间纳入对于就诊时间的logistic回归分析,发现均与就诊时间无相关性。结论非工作时间就诊的STEMI患者在接受心电图、心脏损伤标志物检测及PCI治疗方面无延误,院内病死率同工作时间就诊的患者并无差异。
