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Herzinfarktnetzwerk Region Augsburg (HERA)

Einjahresergebnisse

Network myocardial infarction Augsburg (HERA)

First year results

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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.

Abstract

Background

The registry of the Network Myocardial Infarction Augsburg (HERA) investigates prognosis relevant therapy time intervals after implementation of a (supra) regional network for primary percutaneous catheter intervention (PCI) in ST-elevation myocardial infarction (STEMI) at a maximum care hospital in a mixed urban and rural area.

Material and methods

A total of 250 consecutive patients with STEMI were enrolled from 1st May 2007 until 15th May 2008. Prognosis relevant therapy time intervals, presence of a 12-lead ECG and medication on site were documented in a standardized manner.

Results

Median pain-to-contact time (P2CT) was 71 min, contact-to-door time (C2DT) 56 min, door-to-balloon time (D2BT) 65 min and contact-to-balloon time (C2BT) 121 min. Of the patients admitted via ambulance transfer 80% showed a D2BT of <90 min and on site 12-lead ECG was performed in 82%. Significant reduction of D2BT was possible by direct emergency transfer to the catheterization laboratory (cath lab).

Conclusions

C2BT and D2BT compared favorably with published data from studies and registries and nearly fulfilled guideline requirements. American College of Cardiology (ACC)/American Heart Association (AHA) targets of a D2BT <90 min in >75% of patients have already been achieved. Further reduction of D2BT would be possible especially by direct ambulance transfer to the catheterization laboratory. A precondition for this is reliable STEMI diagnosis with recording of a 12-lead ECG on site.

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Abbreviations

ACC:

American College of Cardiology

AHA:

American Heart Association

C2BT:

„Contact-to-balloon time“, Zeit vom Arzt-Erstkontakt bis zum Beginn der Koronarintervention

C2DT:

„Contact-to-door time“, Zeit vom Arzt-Erstkontakt bis zur Krankenhausaufnahme

C2NT:

„Contact-to-needle time“, Zeit vom Arzt-Erstkontakt bis Start einer Lysetherapie

D2BT:

„Door-to-balloon time“, Zeit von der Krankenhausaufnahme bis zum Beginn der Koronarintervention

D2NT:

„Door-to-needle time“, Zeit von der Krankenhausaufnahme bis zum Start einer Lysetherapie

ESC:

European Society of Cardiology

HERA:

Herzinfarktnetzwerk Region Augsburg

P2CT:

„Pain-to-contact time“, Zeit vom Schmerzbeginn bis zum Arzt-Erstkontakt

PPCI:

Primäre perkutane Koronarintervention

STEMI:

ST-Strecken-Hebungsinfarkt

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Danksagung

Es wird dem ZRF Zweckverband Rettungsdienst Augsburg, den Notärzten und Kooperationskliniken (Aichach, Bobingen, Dillingen, Donauwörth, Friedberg, Schwabmünchen und Wertingen) gedankt. Darüber hinaus gilt unser Dank dem Personal der Intensivstation und des Herzkatheterlabors, den interventionellen Kardiologen und den Kollegen der Herzchirurgie.

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Authors and Affiliations

  1. I. Medizinische Klinik, Klinikum Augsburg, Herzzentrum Augsburg-Schwaben, Stenglinstr. 2, 86156, Augsburg, Deutschland

    C. Thilo, A. Blüthgen, B. Kuch & W. von Scheidt

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  1. C. Thilo
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  2. A. Blüthgen
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  3. B. Kuch
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  4. W. von Scheidt
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Correspondence to C. Thilo.

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Thilo, C., Blüthgen, A., Kuch, B. et al. Herzinfarktnetzwerk Region Augsburg (HERA). Notfall Rettungsmed 14, 128–134 (2011). https://doi.org/10.1007/s10049-010-1335-6

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  • DOI: https://doi.org/10.1007/s10049-010-1335-6

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