急性心筋梗塞搬送時に救急隊のpre-hospital ECGが 再灌流療法に及ぼす有用性の検討(横浜心疾患研究会)
【目的】急性心筋梗塞(AMI)搬送時に救急隊の12誘導ECG(PH-ECG)が再灌流に及ぼす影響を検討した．【対象】2010～2012年に横浜心疾患救急で搬送されカテーテル治療したAMI患者882名．【方法】PH-ECGの有無と，来院からカテ室までの時間(D2CCL)，初回バルーン拡張までの時間(D2B)，TIMI grade 2/3が得られるまでの時間(D2R)を梗塞タイプと部位で後ろ向きに検討した．【結果】PH-ECG群は未施行群と比較し全症例，ST上昇型梗塞(STEMI)群でD2CCL，D2Rの有意な短縮を，非ST上昇型梗塞(NSTEMI)群ではD2Rで有意な短縮を認めた．梗塞部位(前壁...
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| Published in | 日本冠疾患学会雑誌 Vol. 20; no. 3; pp. 195 - 200 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
特定非営利活動法人 日本冠疾患学会
2014
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1341-7703 2187-1949 |
| DOI | 10.7793/jcoron.20.13-00017 |
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| Abstract | 【目的】急性心筋梗塞(AMI)搬送時に救急隊の12誘導ECG(PH-ECG)が再灌流に及ぼす影響を検討した．【対象】2010～2012年に横浜心疾患救急で搬送されカテーテル治療したAMI患者882名．【方法】PH-ECGの有無と，来院からカテ室までの時間(D2CCL)，初回バルーン拡張までの時間(D2B)，TIMI grade 2/3が得られるまでの時間(D2R)を梗塞タイプと部位で後ろ向きに検討した．【結果】PH-ECG群は未施行群と比較し全症例，ST上昇型梗塞(STEMI)群でD2CCL，D2Rの有意な短縮を，非ST上昇型梗塞(NSTEMI)群ではD2Rで有意な短縮を認めた．梗塞部位(前壁，下壁，後側壁)いずれもD2CCL，D2Rで有意な短縮を認めた．【結論】PH-ECGはSTEMIだけではなくNSTEMIでも再灌流時間の短縮に有効であり，梗塞部位に関わらず再灌流時間の短縮が期待される． |
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| AbstractList | 【目的】急性心筋梗塞(AMI)搬送時に救急隊の12誘導ECG(PH-ECG)が再灌流に及ぼす影響を検討した．【対象】2010～2012年に横浜心疾患救急で搬送されカテーテル治療したAMI患者882名．【方法】PH-ECGの有無と，来院からカテ室までの時間(D2CCL)，初回バルーン拡張までの時間(D2B)，TIMI grade 2/3が得られるまでの時間(D2R)を梗塞タイプと部位で後ろ向きに検討した．【結果】PH-ECG群は未施行群と比較し全症例，ST上昇型梗塞(STEMI)群でD2CCL，D2Rの有意な短縮を，非ST上昇型梗塞(NSTEMI)群ではD2Rで有意な短縮を認めた．梗塞部位(前壁，下壁，後側壁)いずれもD2CCL，D2Rで有意な短縮を認めた．【結論】PH-ECGはSTEMIだけではなくNSTEMIでも再灌流時間の短縮に有効であり，梗塞部位に関わらず再灌流時間の短縮が期待される． |
| Author | 大岩, 功治 平山, 篤志 木村, 一雄 田原, 良雄 八幡, 貴治 井上, 尊文 |
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| References | 17)Tahara Y, Kimura K: The clinical significance of emergency cardiovascular care system including prehospital 12-lead electrocardiogram for acute coronary syndrome. J Jpn Coron Assoc 2012; 18: 84-88 (in Japanese 1)O'Connor RE, Brady W, Brooks SC, et al: Part 10: acute coronary syndromes: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010; 122: S787-S817 18)Cudnik MT, Frank Peacock W, Diercks DB, et al: Prehospital electrocardiograms (ECGs) do not improve the process of emergency department care in hospitals with higher usage of ECGs in non-ST-segment elevation myocardial infarction patients. Clin Cardiol 2009; 32: 668-675 6)Nallamothu BK, Bates ER, Herrin J, et al: Times to treatment in transfer patients undergoing primary percutaneous coronary intervention in the United States: National Registry of Myocardial Infarction (NRMI)-3/4 analysis. Circulation 2005; 111: 761-767 13)Trivedi K, Schuur JD, Cone DC: Can paramedics read ST-segment elevation myocardial infarction on prehospital 12-lead electrocardiograms? 2009; 13: 207-214 2)木村一雄，瀬尾宏美，菊池 研，他：第5章 急性冠症候群(ACS)．JRC蘇生ガイドライン2010(監修日本蘇生協議会 日本救急医療財団)．へるす出版，東京，2011, 227-281 19)Roe MT, Parsons LS, Pollack CV Jr, et al: Quality of care by classification of myocardial infarction: treatment patterns for ST-segment elevation vs non-ST-segment elevation myocardial infarction. Arch Intern Med 2005; 165: 1630-1636 8)Le May MR, Dionne R, Maloney J, et al: Diagnostic performance and potential clinical impact of advanced care paramedic interpretation of ST-segment elevation myocardial infarction in the field. CJEM 2006; 8: 401-407 14)Whitbread M, Leah V, Bell T, et al: Recognition of ST elevation by paramedics. Emerg Med J 2002; 19: 66-67 20)Rathore SS, Curtis JP, Chen J, et al: National Cardiovascular Data Registry; Association of door-to-balloon time and mortality in patients admitted to hospital with ST elevation myocardial infarction: national cohort study. BMJ 2009; 338: b1807 4)Le May MR, So DY, Dionne R, et al: A citywide protocol for primary PCI in ST-segment elevation myocardial infarction. N Engl J Med 2008; 358: 231-240 16)Ting HH, Krumholz HM, Bradley EH, et al: Implementation and integration of prehospital ECGs into systems of care for acute coronary syndrome: a scientific statement from the American Heart Association Interdisciplinary Council on Quality of Care and Outcomes Research, Emergency Cardiovascular Care Committee, Council on Cardiovascular Nursing, and Council on Clinical Cardiology. Circulation 2008; 118: 1066-1079 11)Millar-Craig MW, Joy AV, Adamowicz M, et al: Reduction in treatment delay by paramedic ECG diagnosis of myocardial infarction with direct CCU admission. Heart 1997; 78: 456-461 3)Le May MR, Davies RF, Dionne R, et al: Comparison of early mortality of paramedic-diagnosed ST-segment elevation myocardial infarction with immediate transport to a designated primary percutaneous coronary intervention center to that of similar patients transported to the nearest hospital. Am J Cardiol 2006; 98: 1329-1333 7)Feldman JA, Brinsfield K, Bernard S, et al: Real-time parademic compared with blinded physician identification of ST-segment elevation myocardial infarction: results of an observational study. J Am Coll Cardiol 2007; 50: 509-513 9)van't Hof AW, Rasoul S, van de Wetering H, et al: Feasibility and benefit of prehospital diagnosis, triage, and therapy by paramedics only in patients who are candidates for primary angioplasty for acute myocardial infarction. Am Heart J 2006; 151: 1255.e1-1255.e5 10)Foster DB, Dufendach JH, Barkdoll CM, et al: Prehospital recognition of AMI using independent nurse/paramedic 12-lead ECG evaluation: impact on in-hospital times to thrombolysis in a rural community hospital. Am J Emerg Med 1994; 12: 25-31 5)Meadows-Pitt M, Fields W: The The Impact of Prehospital 12-Lead Electrocardiograms on Door-to-Balloon Time in Patients With ST-Elevation Myocardial Infarction. J Emerg Nurs 2013 Mar 7 12)Pitt K: Prehospital section of patients for thrombolysis by paramedics. Emerg Med J 2002; 19: 260-263 15)Cantor WJ, Hoogeveen P, Robert A, et al: Prehospital diagnosis and triage of ST-elevation myocardial infarction by paramedics without advanced care training. Am Heart J 2012; 164: 201-206 |
| References_xml | – reference: 9)van't Hof AW, Rasoul S, van de Wetering H, et al: Feasibility and benefit of prehospital diagnosis, triage, and therapy by paramedics only in patients who are candidates for primary angioplasty for acute myocardial infarction. Am Heart J 2006; 151: 1255.e1-1255.e5 – reference: 15)Cantor WJ, Hoogeveen P, Robert A, et al: Prehospital diagnosis and triage of ST-elevation myocardial infarction by paramedics without advanced care training. Am Heart J 2012; 164: 201-206 – reference: 10)Foster DB, Dufendach JH, Barkdoll CM, et al: Prehospital recognition of AMI using independent nurse/paramedic 12-lead ECG evaluation: impact on in-hospital times to thrombolysis in a rural community hospital. Am J Emerg Med 1994; 12: 25-31 – reference: 14)Whitbread M, Leah V, Bell T, et al: Recognition of ST elevation by paramedics. Emerg Med J 2002; 19: 66-67 – reference: 7)Feldman JA, Brinsfield K, Bernard S, et al: Real-time parademic compared with blinded physician identification of ST-segment elevation myocardial infarction: results of an observational study. J Am Coll Cardiol 2007; 50: 509-513 – reference: 19)Roe MT, Parsons LS, Pollack CV Jr, et al: Quality of care by classification of myocardial infarction: treatment patterns for ST-segment elevation vs non-ST-segment elevation myocardial infarction. Arch Intern Med 2005; 165: 1630-1636 – reference: 20)Rathore SS, Curtis JP, Chen J, et al: National Cardiovascular Data Registry; Association of door-to-balloon time and mortality in patients admitted to hospital with ST elevation myocardial infarction: national cohort study. BMJ 2009; 338: b1807 – reference: 5)Meadows-Pitt M, Fields W: The The Impact of Prehospital 12-Lead Electrocardiograms on Door-to-Balloon Time in Patients With ST-Elevation Myocardial Infarction. J Emerg Nurs 2013 Mar 7 – reference: 11)Millar-Craig MW, Joy AV, Adamowicz M, et al: Reduction in treatment delay by paramedic ECG diagnosis of myocardial infarction with direct CCU admission. Heart 1997; 78: 456-461 – reference: 16)Ting HH, Krumholz HM, Bradley EH, et al: Implementation and integration of prehospital ECGs into systems of care for acute coronary syndrome: a scientific statement from the American Heart Association Interdisciplinary Council on Quality of Care and Outcomes Research, Emergency Cardiovascular Care Committee, Council on Cardiovascular Nursing, and Council on Clinical Cardiology. Circulation 2008; 118: 1066-1079 – reference: 2)木村一雄，瀬尾宏美，菊池 研，他：第5章 急性冠症候群(ACS)．JRC蘇生ガイドライン2010(監修日本蘇生協議会 日本救急医療財団)．へるす出版，東京，2011, 227-281 – reference: 12)Pitt K: Prehospital section of patients for thrombolysis by paramedics. Emerg Med J 2002; 19: 260-263 – reference: 1)O'Connor RE, Brady W, Brooks SC, et al: Part 10: acute coronary syndromes: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2010; 122: S787-S817 – reference: 6)Nallamothu BK, Bates ER, Herrin J, et al: Times to treatment in transfer patients undergoing primary percutaneous coronary intervention in the United States: National Registry of Myocardial Infarction (NRMI)-3/4 analysis. Circulation 2005; 111: 761-767 – reference: 18)Cudnik MT, Frank Peacock W, Diercks DB, et al: Prehospital electrocardiograms (ECGs) do not improve the process of emergency department care in hospitals with higher usage of ECGs in non-ST-segment elevation myocardial infarction patients. Clin Cardiol 2009; 32: 668-675 – reference: 4)Le May MR, So DY, Dionne R, et al: A citywide protocol for primary PCI in ST-segment elevation myocardial infarction. N Engl J Med 2008; 358: 231-240 – reference: 8)Le May MR, Dionne R, Maloney J, et al: Diagnostic performance and potential clinical impact of advanced care paramedic interpretation of ST-segment elevation myocardial infarction in the field. CJEM 2006; 8: 401-407 – reference: 17)Tahara Y, Kimura K: The clinical significance of emergency cardiovascular care system including prehospital 12-lead electrocardiogram for acute coronary syndrome. J Jpn Coron Assoc 2012; 18: 84-88 (in Japanese) – reference: 13)Trivedi K, Schuur JD, Cone DC: Can paramedics read ST-segment elevation myocardial infarction on prehospital 12-lead electrocardiograms? 2009; 13: 207-214 – reference: 3)Le May MR, Davies RF, Dionne R, et al: Comparison of early mortality of paramedic-diagnosed ST-segment elevation myocardial infarction with immediate transport to a designated primary percutaneous coronary intervention center to that of similar patients transported to the nearest hospital. Am J Cardiol 2006; 98: 1329-1333 |
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| Snippet | 【目的】急性心筋梗塞(AMI)搬送時に救急隊の12誘導ECG(PH-ECG)が再灌流に及ぼす影響を検討した．【対象】2010～2012年に横浜心疾患救急で搬送されカテーテル治療したAMI患者882名．【方法】PH-ECGの有無と，来院からカテ室までの時間(D2CCL)，初回バルーン拡張までの時間(D2B)，TIMI... |
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| SubjectTerms | door-to-cardiac catheter laboratory time door-to-reperfusion time myocardial infarction site NSTEMI pre-hospital ECG |
| Title | 急性心筋梗塞搬送時に救急隊のpre-hospital ECGが 再灌流療法に及ぼす有用性の検討(横浜心疾患研究会) |
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