| Summary: | 碩士 === 臺北醫學大學 === 傷害防治學研究所 === 96 === Background: Cardiovascular disease is the leading cause of death in the world. Acute myocardial infarction (AMI) occurred every 20 seconds in U.S. and approximately one-third AMI cases died. Primary percutaneous coronary intervention (PPCI) decreased mortality of AMI significantly and the door-to-balloon time is shorter, the prognosis is better. In this study, we tested whether intra-hospital administration efforts could short door-to balloon time and improve patient’s outcome or not.
Method: We collected AMI subjects who received PPCI in our hospital from 2004 Jan. 01 to 2007 Dec.31. We compare door-to balloon time and clinical outcome before- (from 2004. Jan.01 to 2006 Jun.30) and after- (2006 Jul. 01 to 2007 Dec.31) intra-hospital administration interventions. These interventions included inter-department coordination, regular combined meeting; staff education, cardiology specialist stay in hospital even during off-time and set up AMI-PPCI standard procedure.
Results: Totally 225 consecutive AMI subjects recruited and age was 63.4 ± 13.5 years, male accounted for 79.1%. There were no significant difference in patient’s characteristics between before-intervention group (114 cases) and after-intervention group (111 cases). Our data demonstrated administration interventions shorted door-to-I.V. set time significantly by 13 minutes (from 39 ± 10.1 to 16.7 ± 6.6 min, p<0.05), door-to-cardiology visit time was shorted by 72 minutes (from 185.9 ± 26.9 to 113.9 ± 15.9 min, p<0.05), door-to-cath lab time was shorted by 31 minutes (from 276 ± 24.6 to 245.3 ± 27.5 min, p<0.05), and door-to-balloon time was shorted by 46 minutes (from 308 ± 25.3 to 261.8 ± 27.8 min, p<0.05) in the after-intervention group. These interventions improved patients’ outcome in decrease of severity of illness (Killip Classification) and reduction of need of repeat revascularization (re-PCI 39.5% to 6.3%, p<0.05) significantly, but no significant differences was found in mortality rate (6.1% vs. 8.1%) between two groups.
Conclusion: This is the first study in Taiwan to show that intra-hospital administration effort including education, inter-department coordination, regular combined meeting and cardiology specialist standby in hospital in off-time can short the door-to-balloon time and provide better clinical outcome in patients who received PPCI for acute myocardial injury.
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