病院入院後に診断されたST上昇心筋梗塞
Ross F Garberich1, Jay H Traverse, Michael T Claussen
1Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN.
Circulation
|January 7, 2014
まとめ
入院後,ST上昇心筋梗塞 (ST-elevation myocardial infarction,STEMI) を経験する患者は,治療期間が長くなり,死亡率が高くなります. この高リスクグループには,STEMIプロトコルの中で,改善された結果のために特別な注意が必要です.
科学分野:
- 心臓病学 心臓病学
- 緊急医療 緊急医療
- ヘルスケア・マネジメント・ヘルスケア・マネジメント
背景:
- ST上昇心筋梗塞 (STEMI) の治療時間は,特に緊急医療サービス (EMS) の患者にとって改善されました.
- 症状が現れる前に入院した患者のSTEMI治療時間および治療結果に関するデータは限られている.
研究 の 目的:
- 入院後にSTEMIを発症した患者の特徴とアウトカムを評価する.
- 入院中のSTEMI患者と,EMSまたは自己輸送で出院した患者とを比較する.
主な方法:
- 将来の地域STEMIプログラムデータベースの分析 (2003年3月 - 2013年1月).
- 連続したSTEMI患者3795人を含め,990人 (26.1%) がPCI施設に最初に出院したことに焦点を当てた.
- EMS,自己/家族主導,病院内プレゼンテーショングループに分類される.
主要な成果:
- 入院中のSTEMI患者は高齢で,BMIが高く,高血圧などの併発症が多かった.
- ドアから気球までの時間は,EMS (51分) と比較して,入院患者 (76分) の方が長かった.
- 入院した患者は,より長い入院期間 (5日 vs. 3日) と, signicantly higher 1年死亡率 (16.9% vs. 7.1-10.3%) を経験しました.
結論:
- 入院中のSTEMI患者は,独特で高リスクの集団を表しています.
- これらの患者は,他のSTEMIプレゼンテーションと比較して,遅延した治療とより悪い結果に直面します.
- この脆弱な患者のサブセットについては,さらなる研究と,個別化された戦略が必要である.
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