Abstract
Objective: To investigate the reperfusion time in patients with ST-segment elevation myocardial infarction (STEMI) in Henan Province, China, and discuss the strategies for shortening that period. Methods: The reperfusion times of 1556 STEMI cases in 30 hospitals in Henan Province were analyzed from January 2008 to August 2012, including 736 cases from provincial hospitals, 462 cases from municipal hospitals and 358 cases from country hospitals. The following data: Time period 1 (from symptom onset to first medical contact), Time period 2 (from first medical contact to diagnosis), Time period 3 (from the diagnosis to providing consent), Time period 4 (from the time of providing consent to the beginning of treatment) and Time period 5 (from the beginning of treatment to the patency) were recorded and analyzed. Results: In patients receiving primary percutaneous coronary intervention, the door-to-balloon time of provincial hospitals and municipal hospitals was 172±13 minutes and 251±14 minutes, respectively. The hospitals at both levels had a delay comparison of 90 minutes largely caused by the delay in the time for obtaining consent. In patients receiving thrombolysis treatment, the door-to-needle times of provincial hospitals, municipal hospitals and country hospitals were 86±7, 91±7 and 123±11 minutes, respectively. The hospitals at all levels had delays lasting more than 30 minutes, which was mainly attributed to the delay in the time for providing consent. Compared with the time required by the guidelines, the reperfusion time of patients with STEMI in China is evidently delayed. In terms of China's national conditions, the door-to-balloon time is too general. Therefore, we suggest refining this time as the first medical contact–diagnosis time, consent provision time, therapy preparation time and the start of therapy balloon time. Conclusion: Compared to the time required by the guidelines, the reperfusion time of patients with STEMI in China was obviously greater. In terms of China's national conditions, the door to balloon time is not applicable. So it is suggested to refine it as the first medical contact-diagnosis time, providing consent time, therapy prepare time and the start of therapy – balloon time.
Highlights
According to the hospitals approached by the patients, the 1556 cases were stratified into three subgroups: (1) 736 cases from provincial hospitals with 589 males and 147 females all aged (56±6); (2) 462 cases from municipal hospitals with 370 males and 92 females all aged (57±6); and (3) 358 cases from country hospitals with 289 males and 69 females all aged (60±7)
The successful launch of primary percutaneous coronary intervention has led to the decrease in segment elevation myocardial infarction (STEMI) mortality from 30% to less than
The cardiovascular branch of the Chinese Medical Association developed the 2010 STEMI diagnosis and treatment guidelines based on the ACC/AHA treatment guidelines of STEMI that was updated in 2009,15 with the core idea of achieving reperfusion as early as possible.[3]
Summary
The World Health Organisation reported in 2011 that about 30% of worldwide deaths were caused by cardiovascular diseases. Rates of death from cardiovascular diseases have declined in most developed countries because of improved awareness and timely treatment. People in developing countries are more prone to cardiovascular diseases because of various reasons. More than 3 million people suffer or die from STEMI worldwide.[1] Restoring coronary flow and reperfusing myocardial tissue[2,3] as early as possible is currently proven as the key link to the treatment of STEMI.[4,5] For these patients, saving time is saving life. Among the several known studies, non-systematic reasons are prevalent[9,10] unlike in other countries. This manuscript aims to analyze this issue, mainly about in-hospital delay, to explore a solution suitable for China
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