Skip to main content
Erschienen in: Notfall +  Rettungsmedizin 2/2011

01.03.2011 | Originalien

Herzinfarktnetzwerk Region Augsburg (HERA)

Einjahresergebnisse

verfasst von: Dr. C. Thilo, A. Blüthgen, B. Kuch, W. von Scheidt

Erschienen in: Notfall + Rettungsmedizin | Ausgabe 2/2011

Einloggen, um Zugang zu erhalten

Zusammenfassung

Hintergrund

Das Register des Herzinfarktnetzwerks Region Augsburg (HERA) untersucht prognostisch relevante Therapiezeitintervalle nach (über)regionaler Netzwerketablierung zur Akutintervention bei ST-Strecken-Hebungsinfarkt (STEMI) an einem Maximalversorgungshaus in gemischt städtisch-ländlicher Struktur.

Material und Methoden

Es wurden 250 konsekutive STEMI-Patienten vom 1.5.2007 bis 15.5.2008 eingeschlossen. Prognostisch relevante Therapiezeitintervalle sowie das Vorhandensein eines 12-Kanal-Elektrokardiogramms (EKG) und die Medikation am Einsatzort wurden von Not- bzw. Klinikärzten standardisiert dokumentiert.

Ergebnisse

Die „pain-to-contact time“ betrug im Median 71 min, die „contact-to-door time“ (C2DT) 56 min, die „door-to-balloon time“ (D2BT) 65 min und die „contact-to-balloon time“ 121 min. Insgesamt 80% der Patienten mit primärer Notarztversorgung hatten eine D2BT von <90 min. Bei 82% der Patienten wurde vom Notarzt ein 12-Kanal-EKG angefertigt. Eine Reduktion der D2BT wurde durch direkte Übergabe im Herzkatheterlabor erreicht.

Schlussfolgerungen

C2BT und D2BT sind niedriger als in den meisten publizierten Studien und Registern und kommen den Vorgaben der Leitlinien nahe. Die Vorgabe des/der American College of Cardiology (ACC)/American Heart Association (AHA) einer D2BT von <90 min bei >75% aller Patienten wird bereits erfüllt. Eine weitere Reduktion der D2BT wäre möglich, insbesondere durch direkte Patientenübergabe durch den Notarzt im Herzkatheterlabor. Dies setzt jedoch die verlässliche STEMI-Diagnose am Einsatzort mittels 12-Kanal-EKG voraus.
Literatur
1.
Zurück zum Zitat Antman EM, Hand M, Armstrong PW et al (2008) 2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 51:210–247PubMedCrossRef Antman EM, Hand M, Armstrong PW et al (2008) 2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 51:210–247PubMedCrossRef
2.
Zurück zum Zitat Bjorklund E, Stenestrand U, Lindback J et al (2006) Pre-hospital thrombolysis delivered by paramedics is associated with reduced time delay and mortality in ambulance-transported real-life patients with ST-elevation myocardial infarction. Eur Heart J 27:1146–1152PubMedCrossRef Bjorklund E, Stenestrand U, Lindback J et al (2006) Pre-hospital thrombolysis delivered by paramedics is associated with reduced time delay and mortality in ambulance-transported real-life patients with ST-elevation myocardial infarction. Eur Heart J 27:1146–1152PubMedCrossRef
3.
Zurück zum Zitat Boersma E (2006) Does time matter? A pooled analysis of randomized clinical trials comparing primary percutaneous coronary intervention and in-hospital fibrinolysis in acute myocardial infarction patients. Eur Heart J 27:779–788PubMedCrossRef Boersma E (2006) Does time matter? A pooled analysis of randomized clinical trials comparing primary percutaneous coronary intervention and in-hospital fibrinolysis in acute myocardial infarction patients. Eur Heart J 27:779–788PubMedCrossRef
4.
Zurück zum Zitat Bonnefoy E, Steg PG, Boutitie F et al (2009) Comparison of primary angioplasty and pre-hospital fibrinolysis in acute myocardial infarction (CAPTIM) trial: a 5-year follow-up. Eur Heart J 1598–1606 Bonnefoy E, Steg PG, Boutitie F et al (2009) Comparison of primary angioplasty and pre-hospital fibrinolysis in acute myocardial infarction (CAPTIM) trial: a 5-year follow-up. Eur Heart J 1598–1606
5.
Zurück zum Zitat Bradley EH, Herrin J, Wang Y et al (2006) Strategies for reducing the door-to-balloon time in acute myocardial infarction. N Engl J Med 355:2308–2320PubMedCrossRef Bradley EH, Herrin J, Wang Y et al (2006) Strategies for reducing the door-to-balloon time in acute myocardial infarction. N Engl J Med 355:2308–2320PubMedCrossRef
6.
Zurück zum Zitat Brown JP, Mahmud E, Dunford JV, Ben-Yehuda O (2008) Effect of prehospital 12-lead electrocardiogram on activation of the cardiac catheterization laboratory and door-to-balloon time in ST-segment elevation acute myocardial infarction. Am J Cardiol 101:158–161PubMedCrossRef Brown JP, Mahmud E, Dunford JV, Ben-Yehuda O (2008) Effect of prehospital 12-lead electrocardiogram on activation of the cardiac catheterization laboratory and door-to-balloon time in ST-segment elevation acute myocardial infarction. Am J Cardiol 101:158–161PubMedCrossRef
7.
Zurück zum Zitat Canto JG, Zalenski RJ, Ornato JP et al (2002) Use of emergency medical services in acute myocardial infarction and subsequent quality of care: observations from the national registry of myocardial infarction 2. Circulation 106:3018–3023PubMedCrossRef Canto JG, Zalenski RJ, Ornato JP et al (2002) Use of emergency medical services in acute myocardial infarction and subsequent quality of care: observations from the national registry of myocardial infarction 2. Circulation 106:3018–3023PubMedCrossRef
8.
Zurück zum Zitat Chen ZM, Pan HC, Chen YP et al (2005) Early intravenous then oral metoprolol in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 366:1622–1632PubMedCrossRef Chen ZM, Pan HC, Chen YP et al (2005) Early intravenous then oral metoprolol in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet 366:1622–1632PubMedCrossRef
9.
Zurück zum Zitat Curtis JP, Portnay EL, Wang Y et al (2006) The pre-hospital electrocardiogram and time to reperfusion in patients with acute myocardial infarction, 2000–2002: findings from the national registry of myocardial infarction-4. J Am Coll Cardiol 47:1544–1552PubMedCrossRef Curtis JP, Portnay EL, Wang Y et al (2006) The pre-hospital electrocardiogram and time to reperfusion in patients with acute myocardial infarction, 2000–2002: findings from the national registry of myocardial infarction-4. J Am Coll Cardiol 47:1544–1552PubMedCrossRef
10.
Zurück zum Zitat Danchin N, Coste P, Ferrieres J et al (2008) Comparison of thrombolysis followed by broad use of percutaneous coronary intervention with primary percutaneous coronary intervention for ST-segment-elevation acute myocardial infarction: data from the French registry on acute ST-elevation myocardial infarction (FAST-MI). Circulation 118:268–276PubMedCrossRef Danchin N, Coste P, Ferrieres J et al (2008) Comparison of thrombolysis followed by broad use of percutaneous coronary intervention with primary percutaneous coronary intervention for ST-segment-elevation acute myocardial infarction: data from the French registry on acute ST-elevation myocardial infarction (FAST-MI). Circulation 118:268–276PubMedCrossRef
11.
Zurück zum Zitat Danchin N, Durand E, Blanchard D (2008) Pre-hospital thrombolysis in perspective. Eur Heart J 29:2835–2842PubMedCrossRef Danchin N, Durand E, Blanchard D (2008) Pre-hospital thrombolysis in perspective. Eur Heart J 29:2835–2842PubMedCrossRef
12.
Zurück zum Zitat Dhruva VN, Abdelhadi SI, Anis A et al (2007) ST-Segment analysis using wireless technology in acute myocardial infarction (STAT-MI) trial. J Am Coll Cardiol 50:509–513PubMedCrossRef Dhruva VN, Abdelhadi SI, Anis A et al (2007) ST-Segment analysis using wireless technology in acute myocardial infarction (STAT-MI) trial. J Am Coll Cardiol 50:509–513PubMedCrossRef
13.
Zurück zum Zitat Diercks DB, Kirk JD, Lindsell CJ et al (2006) Door-to-ECG time in patients with chest pain presenting to the ED. Am J Emerg Med 24:1–7PubMedCrossRef Diercks DB, Kirk JD, Lindsell CJ et al (2006) Door-to-ECG time in patients with chest pain presenting to the ED. Am J Emerg Med 24:1–7PubMedCrossRef
14.
Zurück zum Zitat Eagle KA, Nallamothu BK, Mehta RH et al (2008) Trends in acute reperfusion therapy for ST-segment elevation myocardial infarction from 1999 to 2006: we are getting better but we have got a long way to go. Eur Heart J 29:609–617PubMedCrossRef Eagle KA, Nallamothu BK, Mehta RH et al (2008) Trends in acute reperfusion therapy for ST-segment elevation myocardial infarction from 1999 to 2006: we are getting better but we have got a long way to go. Eur Heart J 29:609–617PubMedCrossRef
15.
Zurück zum Zitat Kalla K, Christ G, Karnik R et al (2006) Implementation of guidelines improves the standard of care: the Viennese registry on reperfusion strategies in ST-elevation myocardial infarction (Vienna STEMI registry). Circulation 113:2398–2405PubMedCrossRef Kalla K, Christ G, Karnik R et al (2006) Implementation of guidelines improves the standard of care: the Viennese registry on reperfusion strategies in ST-elevation myocardial infarction (Vienna STEMI registry). Circulation 113:2398–2405PubMedCrossRef
16.
Zurück zum Zitat Keeley EC, Boura JA, Grines CL (2006) Comparison of primary and facilitated percutaneous coronary interventions for ST-elevation myocardial infarction: quantitative review of randomised trials. Lancet 367:579–588PubMedCrossRef Keeley EC, Boura JA, Grines CL (2006) Comparison of primary and facilitated percutaneous coronary interventions for ST-elevation myocardial infarction: quantitative review of randomised trials. Lancet 367:579–588PubMedCrossRef
17.
Zurück zum Zitat Keeley EC, Boura JA, Grines CL (2003) Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet 361:13–20PubMedCrossRef Keeley EC, Boura JA, Grines CL (2003) Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet 361:13–20PubMedCrossRef
18.
Zurück zum Zitat Löwel H MC, Heier M, Hörmann A, Scheidt W von (2006) Herzinfarkt und koronare Sterblichkeit in Süddeutschland. Dtsch Arztebl 103:A616–A622 Löwel H MC, Heier M, Hörmann A, Scheidt W von (2006) Herzinfarkt und koronare Sterblichkeit in Süddeutschland. Dtsch Arztebl 103:A616–A622
19.
Zurück zum Zitat McNamara RL, Herrin J, Bradley EH et al (2006) Hospital improvement in time to reperfusion in patients with acute myocardial infarction, 1999 to 2002. J Am Coll Cardiol 47:45–51PubMedCrossRef McNamara RL, Herrin J, Bradley EH et al (2006) Hospital improvement in time to reperfusion in patients with acute myocardial infarction, 1999 to 2002. J Am Coll Cardiol 47:45–51PubMedCrossRef
20.
Zurück zum Zitat McNamara RL, Wang Y, Herrin J et al (2006) Effect of door-to-balloon time on mortality in patients with ST-segment elevation myocardial infarction. J Am Coll Cardiol 47:2180–2186PubMedCrossRef McNamara RL, Wang Y, Herrin J et al (2006) Effect of door-to-balloon time on mortality in patients with ST-segment elevation myocardial infarction. J Am Coll Cardiol 47:2180–2186PubMedCrossRef
21.
Zurück zum Zitat Nallamothu B, Fox KA, Kennelly BM et al (2007) Relationship of treatment delays and mortality in patients undergoing fibrinolysis and primary percutaneous coronary intervention. The global registry of acute coronary events. Heart 93:1552–1555PubMedCrossRef Nallamothu B, Fox KA, Kennelly BM et al (2007) Relationship of treatment delays and mortality in patients undergoing fibrinolysis and primary percutaneous coronary intervention. The global registry of acute coronary events. Heart 93:1552–1555PubMedCrossRef
22.
Zurück zum Zitat Nallamothu BK, Bradley EH, Krumholz HM (2007) Time to treatment in primary percutaneous coronary intervention. N Engl J Med 357:1631–1638PubMedCrossRef Nallamothu BK, Bradley EH, Krumholz HM (2007) Time to treatment in primary percutaneous coronary intervention. N Engl J Med 357:1631–1638PubMedCrossRef
23.
Zurück zum Zitat Pinto DS, Kirtane AJ, Nallamothu BK et al (2006) Hospital delays in reperfusion for ST-elevation myocardial infarction: implications when selecting a reperfusion strategy. Circulation 114:2019–2025PubMedCrossRef Pinto DS, Kirtane AJ, Nallamothu BK et al (2006) Hospital delays in reperfusion for ST-elevation myocardial infarction: implications when selecting a reperfusion strategy. Circulation 114:2019–2025PubMedCrossRef
24.
Zurück zum Zitat Steg PG, Bonnefoy E, Chabaud S et al (2003) Impact of time to treatment on mortality after prehospital fibrinolysis or primary angioplasty: data from the CAPTIM randomized clinical trial. Circulation 108:2851–2856PubMedCrossRef Steg PG, Bonnefoy E, Chabaud S et al (2003) Impact of time to treatment on mortality after prehospital fibrinolysis or primary angioplasty: data from the CAPTIM randomized clinical trial. Circulation 108:2851–2856PubMedCrossRef
25.
Zurück zum Zitat Stenestrand U, Lindback J, Wallentin L (2006) Long-term outcome of primary percutaneous coronary intervention vs prehospital and in-hospital thrombolysis for patients with ST-elevation myocardial infarction. JAMA 296:1749–1756PubMedCrossRef Stenestrand U, Lindback J, Wallentin L (2006) Long-term outcome of primary percutaneous coronary intervention vs prehospital and in-hospital thrombolysis for patients with ST-elevation myocardial infarction. JAMA 296:1749–1756PubMedCrossRef
26.
Zurück zum Zitat Van de Werf F et al – Assessment of the safety and efficacy of a new treatment strategy with percutaneous coronary intervention (ASSENT-4 PCI) investigators (2006) Primary versus tenecteplase-facilitated percutaneous coronary intervention in patients with ST-segment elevation acute myocardial infarction (ASSENT-4 PCI): randomised trial. Lancet 367:569–578CrossRef Van de Werf F et al – Assessment of the safety and efficacy of a new treatment strategy with percutaneous coronary intervention (ASSENT-4 PCI) investigators (2006) Primary versus tenecteplase-facilitated percutaneous coronary intervention in patients with ST-segment elevation acute myocardial infarction (ASSENT-4 PCI): randomised trial. Lancet 367:569–578CrossRef
27.
Zurück zum Zitat Van de Werf F, Bax J, Betriu A et al (2008) Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the task force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology. Eur Heart J 29:2909–2945CrossRef Van de Werf F, Bax J, Betriu A et al (2008) Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the task force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology. Eur Heart J 29:2909–2945CrossRef
28.
Zurück zum Zitat Zahn R, Schiele R, Schneider S et al (2001) Primary angioplasty versus intravenous thrombolysis in acute myocardial infarction: can we define subgroups of patients benefiting most from primary angioplasty? Results from the pooled data of the maximal individual therapy in acute myocardial infarction registry and the myocardial infarction registry. J Am Coll Cardiol 37:1827–1835PubMedCrossRef Zahn R, Schiele R, Schneider S et al (2001) Primary angioplasty versus intravenous thrombolysis in acute myocardial infarction: can we define subgroups of patients benefiting most from primary angioplasty? Results from the pooled data of the maximal individual therapy in acute myocardial infarction registry and the myocardial infarction registry. J Am Coll Cardiol 37:1827–1835PubMedCrossRef
29.
Zurück zum Zitat Zahn R, Vogt A, Zeymer U et al (2005) In-hospital time to treatment of patients with acute ST elevation myocardial infarction treated with primary angioplasty: determinants and outcome. Results from the registry of percutaneous coronary interventions in acute myocardial infarction of the Arbeitsgemeinschaft leitender kardiologischer Krankenhausarzte. Heart 91:1041–1046PubMedCrossRef Zahn R, Vogt A, Zeymer U et al (2005) In-hospital time to treatment of patients with acute ST elevation myocardial infarction treated with primary angioplasty: determinants and outcome. Results from the registry of percutaneous coronary interventions in acute myocardial infarction of the Arbeitsgemeinschaft leitender kardiologischer Krankenhausarzte. Heart 91:1041–1046PubMedCrossRef
30.
Zurück zum Zitat Zeymer U, Arntz HR, Dirks B et al (2009) Reperfusion rate and inhospital mortality of patients with ST segment elevation myocardial infarction diagnosed already in the prehospital phase: results of the german prehospital myocardial infarction registry (PREMIR). Resuscitation 80:402–406PubMedCrossRef Zeymer U, Arntz HR, Dirks B et al (2009) Reperfusion rate and inhospital mortality of patients with ST segment elevation myocardial infarction diagnosed already in the prehospital phase: results of the german prehospital myocardial infarction registry (PREMIR). Resuscitation 80:402–406PubMedCrossRef
Metadaten
Titel
Herzinfarktnetzwerk Region Augsburg (HERA)
Einjahresergebnisse
verfasst von
Dr. C. Thilo
A. Blüthgen
B. Kuch
W. von Scheidt
Publikationsdatum
01.03.2011
Verlag
Springer-Verlag
Erschienen in
Notfall + Rettungsmedizin / Ausgabe 2/2011
Print ISSN: 1434-6222
Elektronische ISSN: 1436-0578
DOI
https://doi.org/10.1007/s10049-010-1335-6

Weitere Artikel der Ausgabe 2/2011

Notfall +  Rettungsmedizin 2/2011 Zur Ausgabe