STセグメント上昇心筋梗塞の患者の治療時間と入院死亡率 (2018年-2021年)
James G Jollis1,2, Christopher B Granger2, Jessica K Zègre-Hemsey3
1Lindner Center for Research and Education, Cincinnati, Ohio.
JAMA
|November 6, 2022
まとめ
ST上昇性心筋梗塞 (STEMI) の早期治療は,入院死亡率を大幅に減少させます. しかし,ほとんどの病院は,2018年から2021年の間に,特に病院間移転の治療時間目標を達成しなかった.
科学分野:
- 心臓病科
- 公衆衛生
背景:
- 米国国内ガイドラインは,STセグメント上昇性心筋梗塞 (STEMI) に対して,心筋損傷を最小限に抑えるために時間的に敏感な治療を推奨しています.
- これらの治療時間の目標に固執することは 患者の治療結果を改善するために不可欠です
研究 の 目的:
- STEMI患者に対するプロセス・対策と成果を 国内レジストリで評価する
- 推奨された治療時間と入院死亡率との関連を評価する.
主な方法:
- 横断的な研究では,Get With The Guidelines-冠動脈疾患レジストリ (2018年第2四半期-2021年第3四半期) の114,871人のSTEMI患者のデータを分析した.
- 重要な指標には,治療時間,入院死亡率,システム目標の遵守 (例えば90分または120分以内のPCI) が含まれていた.
主要な成果:
- 経皮冠動脈干渉 (PCI) までの平均時間は,呈現方法によって変化し,移植された患者ではより長い遅延でした.
- 病院での死亡率は,すべての治療方法において,目標時間内に治療された患者で著しく低下した.
- システム目標はほとんど達成されず,120分以内に治療を受けた患者はわずか17%でした.
結論:
- 適時なSTEMI治療は,入院死亡率の減少と関連しています.
- 確立されたガイドラインにもかかわらず,治療時間目標の遵守は,特に病院間の移送では最適ではありません.
- STEMI治療の目標を達成するために,システムのパフォーマンスをさらに改善する必要があります.
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