精神疾患の患者におけるST上昇心筋梗塞の診断と管理の格差
Dorian Garin1, Erik Mendola2, Yannick Faucherre1
1Department of Cardiology, University and Hospital Fribourg, Chem. des Pensionnats 2/6, Fribourg CH-1708, Switzerland.
European heart journal. Quality of care & clinical outcomes
|August 30, 2025
まとめ
精神疾患 (MHC) の患者は,ST上昇心筋梗塞 (STEMI) の治療に遅延し,より大きな心筋梗塞と心血管疾患のリスクが増加しました. これはMHC患者の緊急心臓治療の格差を強調しています.
科学分野:
- 心臓病科
- 精神科
- 公衆衛生
背景:
- 精神疾患 (MHC) の患者は,診断と治療に遅延することが多い.
- 専用のST上昇心筋梗塞 (STEMI) 速攻プロトコルは,これらの重要な心疾患の治療を早めることを目的としています.
研究 の 目的:
- STEMI 急速治療のプロトコルにもかかわらず,MHC の患者がより長い治療遅延とより悪い結果を経験するかどうかを評価する.
- STEMI患者におけるMHCに関連した特定の遅延および有害事象を特定する.
主な方法:
- STEMI患者の将来的なEVALFASTレジストラの分析
- STEMI診断時に記録されたMHCに基づいて,MHCコホートに患者の分類.
- 一般化された線形モデルとコックスの回帰を用いた統計的分析.
主要な成果:
- MHC患者 (12. 1%) は,プロトコルにもかかわらず,診断までの最初の医療接触 (FMC) (+16. 4分) と,FMCから気球までの時間 (+18. 6分) が長かった.
- MHCコホートは,より大きな心筋梗塞のサイズ (ピークCK- MB+71. 3U/ L) と,30日間のMACCE (aHR1. 82) と5年後の心血管死 (aHR2. 04) のリスクの増加を示した.
- 遅延は緊急治療室に自己紹介した患者でより顕著でした.
結論:
- STEMI患者におけるMHCは,迅速なプロトコルに関係なく,早期治療に重大な遅延が伴う.
- これらの遅延は心臓発作の大きさに寄与し,短期的および長期的不良心血管疾患のリスクを高めます.
- 精神疾患はSTEMIの適時かつ効果的な治療に障壁となり,長期的な心血管疾患に影響を及ぼします.
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