闭塞性心肌梗死诊断与治疗的公平性差距

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2025-05-01 DOI:10.1016/j.cjco.2025.01.016

Varunaavee Sivashanmugathas BSc , Mazen El-Baba MD, MSc , Marcella K. Jones MD , Alex Kiss PhD , H. Pendell Meyers MD , Stephen W. Smith MD , Lucas B. Chartier MD, CM, MPH, MBA , Jesse T.T. McLaren MD

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引用次数: 0

摘要

背景：由于年龄和性别等社会人口因素，符合st段抬高型心肌梗死（STEMI）标准的闭塞性心肌梗死（OMI）患者会经历不公平的护理延误。不符合STEMI标准并作为非STEMI患者入院的OMI患者会经历进一步的延误。然而，OMI护理中是否存在公平差距尚不清楚。方法回顾性分析我院2021年1月1日至2022年12月31日经2个专科急诊科收治的急性冠状动脉综合征患者。患者被分为以下两组：ami(伴有心肌梗死溶栓的急性罪魁祸首[TIMI] 0-2血流，或伴有TIMI 3血流的急性罪魁祸首，且肌钙蛋白I水平>；10000 ng / L;或者如果没有血管造影，肌钙蛋白I水平；10000 ng/L合并超声心动图新的局部壁运动异常)；非OMI（未达到OMI阈值的MI）；或MI排除。结果662例患者中，OMI患者260例，非OMI患者296例，排除MI患者106例。在260例OMI患者中，116例作为STEMI患者（真阳性）入院，144例（55.4%）作为非STEMI患者（假阴性）入院。在双变量分析中，具有非典型症状的真阳性STEMI患者有较长的门到心电图（ECG）时间(P <；0.0001)，心电图到置管时间较长(P <；0.001)。假阴性STEMI患者出现非典型症状时从门到ecg的时间较长(P <；0.0001)，非典型症状心电图到置管时间较长（P = 0.003），年龄≥75岁（P = 0.006）。结论true阳性STEMI患者出现不典型症状时，可延迟心电图和置管。一半以上的OMI患者入院时为非stemi患者，老年患者和出现非典型症状的患者进一步出现再灌注延迟。向OMI模式的转变突出了ACS管理中的再灌注延迟和公平差距。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Equity Gaps in the Diagnosis and Treatment of Occlusion Myocardial Infarction

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Equity Gaps in the Diagnosis and Treatment of Occlusion Myocardial Infarction

Background

Patients with occlusion myocardial infarction (OMI) who meet the ST-elevation myocardial infarction (STEMI) criteria experience inequitable delays in care, because of sociodemographic factors, such as age and sex. OMI patients who do not meet STEMI criteria and are admitted to the hospital as non-STEMI patients, experience further delays. However, whether equity gaps exist in OMI care remains unknown.

Methods

A retrospective chart review included patients with acute coronary syndrome admitted to the hospital through 2 academic emergency departments, in the period from January 1, 2021 to December 31, 2022. Patients were categorized as having one of the following: OMI (acute culprit with Thrombolysis In Myocardial Infarction [TIMI] 0-2 flow, or acute culprit with TIMI 3 flow, and a troponin I level > 10,000 ng/L; or if they had no angiogram, a troponin I level > 10,000 ng/L plus new regional wall-motion abnormality on echocardiogram); non-OMI (MI that did not meet the OMI threshold); or MI ruled out.

Results

Among 662 charts, 260 were OMI patients, 296 were non-OMI patients, and 106 were patients with MI ruled out. Of the 260 OMI patients, 116 were admitted to the hospital as STEMI patients (true-positive), and 144 (55.4%) were admitted as non-STEMI patients (false-negative). In bivariate analyses, true-positive STEMI patients with atypical symptoms had a longer door-to-electrocardiogram (ECG) time (P < 0.0001) and a longer ECG-to-catheterization time (P < 0.001). False-negative STEMI patients had a longer door-to-ECG time for atypical symptoms (P < 0.0001), a longer ECG-to-catheterization time for atypical symptoms (P = 0.003), and were aged ≥75 years (P = 0.006).

Conclusions

True-positive STEMI patients had delayed ECGs and catheterization for those presenting with atypical symptoms. More than half of those with OMI were admitted as non-STEMI patients, with further reperfusion delays for older patients and those presenting with atypical symptoms. Shifting to the OMI paradigm highlights reperfusion delays and equity gaps in the management of ACS.

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