Nghiên cứu về khả thi của đặt stent mạch vành qua da cho bệnh nhân nhồi máu cơ tim ST-đoạn tăng trong một mạng lưới nhồi máu nông thôn

Clinical Research in Cardiology - Tập 99 - Trang 833-840 - 2010
Ralf Birkemeyer1, Andreas Rillig1, Annette Koch1, Tomislav Miljak1, Markus Kunze1, Udo Meyerfeldt1, Wolfgang Steffen2, Martin Soballa3, Carsten Ranke4, Roland Prassler5, Albert Benzing6, Werner Jung1
1Department of Cardiology, Schwarzwald-Baar-Klinikum, Villingen-Schwenningen, Villingen-Schwenningen, Germany
2Department of Internal Medicine, Gesundheitszentren des Landkreises Rottweil, Rottweil, Germany
3Department of Anesthesiology, Gesundheitszentren des Landkreises Rottweil, Rottweil, Germany
4Department of Internal Medicine, Gesundheitszentren des Landkreises Rottweil, Schramberg, Germany
5Department of Internal Medicine, Städtisches Krankenhaus Oberndorf, Oberndorf, Germany
6Department of Anesthesiology and Intensive Care Medicine, Schwarzwald-Baar-Klinikum, Villingen-Schwenningen, Germany

Tóm tắt

Mục tiêu của nghiên cứu này là đánh giá khả thi của việc thực hiện can thiệp động mạch vành cho bệnh nhân nhồi máu cơ tim ST-đoạn tăng (STEMI) theo hướng dẫn trong điều kiện nông thôn tại Đức và tác động của nó đến sự tái tưới máu và kết quả điều trị. Tất cả bệnh nhân liên tục nhập viện với chẩn đoán nhồi máu cơ tim cấp tính (n = 347) vào bất kỳ bệnh viện nào (5 bệnh viện không xâm lấn và 1 bệnh viện xâm lấn với dịch vụ đặt stent động mạch vành 24/7) trong khu vực nông thôn có 350.000 dân trong năm 2002 (n = 184) và 2005 (n = 163) đều được đưa vào hồ sơ này. Năm 2002, dịch vụ y tế khẩn cấp đã chuyển bệnh nhân STEMI cấp tính đến phòng cấp cứu gần nhất, nơi tổ chức điều trị tái tưới máu (thrombolysis hoặc đặt stent động mạch vành). Năm 2005, tất cả bệnh nhân được chuyển trực tiếp vào phòng can thiệp mà không qua phòng cấp cứu nếu có thể. Tỷ lệ đặt stent động mạch vành tăng từ 53% lên 89% (p < 0.01), tỷ lệ sử dụng thrombolysis giảm từ 27% xuống 2% (p < 0.01) và tỷ lệ không tái tưới máu giảm từ 21% xuống 9% (p < 0.01). Thời gian từ khi bắt đầu cơn đau đến lúc can thiệp đặt stent đã giảm từ 339 phút xuống còn 191 phút (p < 0.01), thời gian từ lần tiếp xúc y tế đầu tiên đến khi đặt bóng trong năm 2005 là 101 phút. Tử suất sau 6 tháng giảm từ 19% xuống còn 10% (p = 0.03). Sau khi chuyển sang một khái niệm đặt stent đồng nhất, có thể quan sát thấy sự gia tăng tỷ lệ tái tưới máu toàn bộ và giảm thiểu thời gian trì hoãn trong mạng lưới nhồi máu nông thôn tại Đức.

Từ khóa

#nhồi máu cơ tim #ST-đoạn tăng #đặt stent động mạch vành #tái tưới máu #tỷ lệ tử vong

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