As time goes by? The fallacy of thrombolysis in STEMI networks

Primary percutaneous coronary intervention (PPCI) is superior to thrombolysis (TL) as reperfusion therapy in ST-elevation myocardial infarction (STEMI). TL is a rapidly available, but semi-effective therapy (effective reperfusion in 50% of patients only), whereas PPCI is a potentially delayed, but highly effective therapy (effective reperfusion in >90%). Since TL loses its efficacy beyond 2–3 h after symptom onset, it is a significant reperfusion alternative to PPCI in early presenters only. The individual decision to treat an early presenter with PPCI or TL requires the evaluation of the time delay between potential start of TL or PPCI, the PCI-related delay (PRD). PRD is greatest, if TL is given in the prehospital setting. Until now, prehospital TL as the most rapidly available reperfusion strategy has failed to demonstrate any prognostic or even any other relevant benefit compared to PPCI in any subgroup of patients, even with time delays for PPCI of up to several hours. On average, a median PRD of at least 90–120 min can be considered a time corridor of prognostic superiority of PPCI over TL. This is already achieved in contemporary registries and myocardial infarction networks.     

Detecting failed thrombolysis in the accident and emergency department

The primary objective in managing a patient with ST segment elevation myocardial infarction (STEMI) is to establish reperfusion in the infarct-related artery and to maintain it. Two approaches to coronary reperfusion are used in the UK - primary angioplasty and intravenous thrombolysis. Primary angioplasty is the gold standard approach to managing STEMI, but in the UK (due to financial, resource and personnel limitations) this is not the first-line treatment. Thrombolytic therapy remains the most widely used approach and the benefits of such an approach are irrefutable; thrombolysis saves lives, reduces infarct size and limits left ventricular dysfunction. However, data from the thrombolytic trials also suggest that 30-40% of patients fail to reperfuse with standard thrombolytic therapy. Similar data demonstrates that patients who do not sustain adequate perfusion in the infarct-related artery have a poor prognosis and increased mortality rates. As long as thrombolysis remains the standard therapy for STEMI, it is important that patients in whom the treatment has been unsuccessful are swiftly recognised and appropriate interventions instituted. The criteria to assess successful reperfusion of the infarct-related artery need to be simple to apply, easy to interpret and non-invasive. This article will discuss the most useful criteria to make such a diagnosis and suggest approaches to enable recognition of 'failed thrombolysis' in the accident and emergency department. The current views on managing failed thrombolysis will conclude the article.     

急性ST段抬高型心肌梗死PPCI后发生再灌注心律失常的危险因素分析

目的分析急性ST段抬高型心肌梗死(STEMI)患者在经直接经皮冠状动脉介入治疗(PPCI)后再灌注心律失常(RA)的发生率及危险因素。方法回顾性分析2018年1月至2019年5月188例经PPCI治疗的STEMI患者的临床资料。利用单因素分析和多因素Logistic回归分析STEMI患者经PPCI治疗后发生RA的危险因素。结果 188例STEMI患者中,87例发生RA设为RA组,未发生RA的101例设为对照组。单因素分析显示,RA组有吸烟史、合并高血压病、合并2型糖尿病、血管开通时间<6 h、合并低钾血症、罪犯血管为右冠患者占比以及肌红蛋白水平高于对照组(P<0.05)。多因素Logistic回归分析显示,合并高血压病、合并2型糖尿病、血管开通时间<6 h、合并低钾血症、罪犯血管为右冠是影响STEMI患者PPCI后发生RA的独立危险因素(P<0.05)。结论对于采取PPCI治疗的STEMI患者,合并高血压病、合并2型糖尿病、血管开通时间<6 h、合并低钾血症、罪犯血管为右冠可增加RA的发生。     

Prevalence and extent of infarct and microvascular obstruction following different reperfusion therapies in ST-elevation myocardial infarction

Background

Microvascular obstruction (MVO) describes suboptimal tissue perfusion despite restoration of infarct-related artery flow. There are scarce data on Infarct Size (IS) and MVO in relation to the mode and timing of reperfusion. We sought to characterise the prevalence and extent of microvascular injury and IS using Cardiovascular magnetic resonance (CMR), in relation to the mode of reperfusion following acute ST-Elevation Myocardial Infarction (STEMI).

Methods

CMR infarct characteristics were measured in 94 STEMI patients (age 61.0 ± 13.1 years) at 1.5 T. Seventy-three received reperfusion therapy: primary percutaneous coronary-intervention (PPCI, n = 47); thrombolysis (n = 12); rescue PCI (R-PCI, n = 8), late PCI (n = 6). Twenty-one patients presented late (>12 hours) and did not receive reperfusion therapy.

Results

IS was smaller in PPCI (19.8 ± 13.2% of LV mass) and thrombolysis (15.2 ± 10.1%) groups compared to patients in the late PCI (40.0 ± 15.6%) and R-PCI (34.2 ± 18.9%) groups, p <0.001. The prevalence of MVO was similar across all groups and was seen at least as frequently in the non-reperfused group (15/21, [76%] v 33/59, [56%], p = 0.21) and to a similar magnitude (1.3 (0.0-2.8) v 0.4 [0.0-2.9]% LV mass, p = 0.36) compared to patients receiving early reperfusion therapy. In the 73 reperfused patients, time to reperfusion, ischaemia area at risk and TIMI grade post-PCI were the strongest independent predictors of IS and MVO.

Conclusions

In patients with acute STEMI, CMR-measured MVO is not exclusive to reperfusion therapy and is primarily related to ischaemic time. This finding has important implications for clinical trials that use CMR to assess the efficacy of therapies to reduce reperfusion injury in STEMI.     

Thrombolysis in acute myocardial infarction: current status

ST-segment elevation myocardial infarction (STEMI) is still a major public health problem in the modern world. Therapeutic options have changed much over the last 20 years, with a shift in favor of mechanical reperfusion over pharmacologic reperfusion. Thrombolytic therapy still has much to offer in the management of STEMI, however, because many patients do not have timely access to a facility with the required expertise for establishing mechanical reperfusion. This review highlights the history of thrombolytic therapy, adjunctive therapies, the relationship with mechanical reperfusion, and potential roles for thrombolysis in the future.     

Myocardial ischemia-reperfusion injury: a neglected therapeutic target

Acute myocardial infarction (MI) is a major cause of death and disability worldwide. In patients with MI, the treatment of choice for reducing acute myocardial ischemic injury and limiting MI size is timely and effective myocardial reperfusion using either thombolytic therapy or primary percutaneous coronary intervention (PPCI). However, the process of reperfusion can itself induce cardiomyocyte death, known as myocardial reperfusion injury, for which there is still no effective therapy. A number of new therapeutic strategies currently under investigation for preventing myocardial reperfusion injury have the potential to improve clinical outcomes in patients with acute MI treated with PPCI.     

ST段抬高型心肌梗死溶栓前后心肌缺血修饰白蛋白浓度与心肌再灌注的关系

[目的]观察ST段抬高型心肌梗死（STEMI）患者溶栓前后血管再通和心肌缺血修饰白蛋白（IMA）浓度变化,探讨两者之间的关系及临床意义.[方法]入选STEMI并于发病6 h之内入院患者共80例,均予常规及尿激酶溶栓治疗,根据2 h后有无再灌注表现将患者分成无灌注组（30例）和再灌注组（50例）,两组病人于溶栓前及溶栓后2 h、4 h、6 h分别采血测IMA浓度,并于8、12、14 h采血测肌酸激酶同工酶（CK-MB）浓度.[结果]两组患者溶栓前IMA浓度无明显差异,溶栓后4～6 hIMA浓度有显著差异（P〈0.05）;再灌注组于心肌再灌注恢复后,IMA提前达峰值并回落至正常,IMA达峰值时间较肌酸激酸同工酶（CK-MB）显著提前（P〈0.05）.[结论]STEMI溶栓后心肌是否恢复再灌注与IMA浓度变化存在相关性.IMA早期明显下降可作为STEMI溶栓后心肌恢复有效再灌注的指标.     

Thrombus aspiration during primary percutaneous coronary intervention improved outcome in patients with STEMI and a large thrombus burden

BackgroundThe benefit of thrombus aspiration (TA) during primary percutaneous coronary intervention (PPCI) to patients with ST-segment elevation myocardial infarction (STEMI) remains controversial. This study aimed to assess TA''s impact on the outcome and prognosis for patients with STEMI and a large thrombus burden during PPCI.MethodsThis retrospective study evaluated consecutive patients with STEMI and a large thrombus burden (thrombolysis in myocardial infraction [TIMI] thrombus grade ≥4) who underwent conventional PPCI (n = 126) or PPCI + TA (n = 208) between February 2017 and January 2019. The procedure outcome and clinical prognosis were compared.ResultsPostprocedural vessel diameter was larger, and corrected TIMI frame count (cTFC) was lower in the PPCI + TA compared with the PPCI group. The proportion of postprocedural TIMI 3 flow was 83.3% in the PPC group and 94.2% in the PPCI+TA group. During the 12-month follow-up, no significant differences existed in the incidence of cardiac death, reinfarction, stent thrombosis, target vessel revascularization, or stroke.ConclusionApplication of TA in patients with STEMI and a large thrombus burden during PPCI may improve the procedural outcome, but it showed no benefit on the clinical prognosis in the 12-month follow-up. Longer follow-up studies are needed to confirm TA''s clinical implications in patients with STEMI.     

Ultrasound enhanced prehospital thrombolysis using microbubbles infusion in patients with acute ST elevation myocardial infarction: pilot of the Sonolysis study

In animal studies, transthoracic ultrasound and microbubbles have shown to dissolve thrombi in ST elevation myocardial infarction (STEMI). To examine this effect in patients, we have initiated the Sonolysis trial. In this pilot study of 10 patients with a first acute STEMI, we investigated the safety and feasibility of this trial. After pretreatment in the ambulance, five patients were randomized to receive microbubbles with three-dimensional (3-D) guided high mechanical index impulses (1.18) for 15 min, whereas the control group received placebo without ultrasound. Subsequently, primary percutaneous coronary intervention (PPCI) was performed, if indicated. All patients successfully underwent study treatment and PPCI. No significant difference between treatment and control group in safety (minor adverse events 2/5 vs. 2/5, p = NS) and outcome (TIMI III flow 3/5 vs. 1/5 respectively, p = 0.23) was recorded. These results demonstrate that the study protocol is feasible in the acute cardiac care setting and safe during treatment and follow-up.     

围术期强化瑞舒伐他汀钙治疗对急性心肌梗死直接经皮冠状动脉介入治疗中冠状动脉血流的影响

目的评估围手术期强化瑞舒伐他汀钙治疗对急性心肌梗死直接经皮冠状动脉介入治疗(PPCI)靶血管开通后即刻冠脉血流的影响。方法收集2018年6月至2019年6月诊断为急性ST段抬高型心肌梗死(STEMI)接受直接PCI治疗的患者122例,根据术前是否强化瑞舒伐他汀治疗分为研究组62例和对照组60例。研究组术前30 min内开始服用瑞舒伐他汀钙20 mg,连续服用7天,20 mg/d,后以10 mg/d长期维持;对照组术前不服用任何他汀类药物,PCI后开始服用瑞舒伐他汀钙10 mg/d,长期维持。观察PPCI靶血管开通后TIMI血流、校正TIMI帧数(Corrected TIMI frame count,CTFC)、住院期间心肌酶学、心电图以及出院后30天超声心动图情况。结果靶血管开通后,研究组CTFC及CTFC大于100帧者(相当于TIMI 0级)均低于对照组(P<0.05)。治疗后,两组肌钙蛋白I、肌酸激酶同工酶、B型利钠肽水平均低于治疗前,梗死相关导联ST段抬高总和明显降低,且研究组低于对照组(均P<0.05);两组超声心动图中左室射血分数、左室舒张末期容积比较,差异无统计学意义(P>0.05)。结论围术期瑞舒伐他汀钙治疗对急性ST段抬高性心肌梗死直接经皮冠状动脉介入治疗可有效的改善冠脉即刻血流,增加心肌组织灌注,具有较好的安全性。     

Acute ST-elevation myocardial infarction: is primary PCI superior to thrombolysis?

Thrombolysis is an established treatment of acute myocardial infarction with persistent ST elevation (STEMI). Thrombolytic agents are most effective in patients who can be treated within two hours of symptom onset. On the other hand, the efficacy of mechanical recanalization (PCI) was consistently shown to be superior to thrombolysis regardless of the duration of symptoms. Recent studies further suggest that it may be preferable for small hospitals to rapidly transfer patients with acute STEMI to a PCI center rather than perform on-site thrombolysis. Therefore, this novel strategy is principally recommended in the updated guidelines of German and international cardiac societies. However, it is emphasized that the transfer-related delay of treatment should not exceed 60-90 minutes.     

预谈话模板对冠状动脉介入治疗急性心肌梗死知情同意时间的影响

目的 探讨预谈话模板对急性ST段抬高心肌梗死（STEMI）直接经皮冠状动脉介入治疗(PPCI)获取知情同意时间及入门至球囊扩张(D to B)时间的影响。方法 选择2016年6月至2018年5月就诊于解放军第九七医院的急性STEMI患者。2016年6月至2017年5月即模板使用前符合入选标准的为常规谈话组,2017年6月至2018年5月符合入选标准的为模板谈话组, 后者统一使用标准化模板进行病情告知及PPCI建议谈话。两组均在获取知情同意后启动导管室,完成PPCI。对比两组获取知情同意时间和D to B时间。结果 两组基础临床情况及梗死相关动脉具有可比性。与常规谈话组（n=52）相比,模板谈话组（n=68）获取知情同意时间显著缩短［（16.1±13.3) min 对 (26.8±12.5) min,P<0.01］;D to B时间明显缩短［(79.7±21.5） min 对 （93.4±22.0） min,P<0.05］。采用模板谈话后患方对PPCI的拒绝率明显降低（11.39% 对 19.40%,P<0.05）。结论 急性ST段抬高心肌梗死冠状动脉介入治疗预谈话模板可提高知情谈话效率,从而缩短获取知情同意时间和D to B时间。     

新型冠状病毒肺炎防控形势下救治策略调整对急性ST段抬高型心肌梗死患者救治效果

目的 在新型冠状病毒肺炎疫情防控形势下,探讨救治策略改变对急性ST段抬高型心肌梗死(ST-segment elevation acute myocardial infarction, STEMI)患者救治的有效性和安全性。方法 选取河北医科大学第二医院心内科在新型冠状病毒肺炎(COVID-19)防控形势期间收治的急性STEMI患者34例纳入研究组,新型冠状病毒肺炎防控常态化期间收治的急性STEMI患者62例纳入对照组,比较两组一般临床资料、再灌注治疗情况[发病至首次医疗接触时间(Onset-to-FMC)、首次医疗接触时间至导丝通过(FMC to wire,FMC-to-W)时间、心肌梗死溶栓治疗试验(thrombolysis in myocardial infarction, TIMI)血流分级、总缺血时间(从症状发作到导丝通过病变的时间)、首次医疗接触时间至开始溶栓(FMC to needle of thrombolysis, FMC-to-N)时间、溶栓再通比例、24 h内接受再灌注治疗比例、支架植入率、住院天数等]、主要不良心血管事件(major adverse cardiac events, MACE)、出血事件、心功能相关指标。结果 研究组Onset-to-FMC时间和总缺血时间明显延长(P<0.05),接受静脉溶栓治疗比例增高,而接受直接经皮冠状动脉介入治疗(primary percutaneous coronary intervention, pPCI)的患者比例降低(P<0.05),支架置入比例、住院天数低于对照组(P<0.05);两组心功能指标比较,研究组入院时血清BNP高于对照组(P=0.042)。结论 在新型冠状病毒肺炎疫情防控形势下,STEMI患者Onset-to-FMC时间和总缺血时间明显延长,接受静脉溶栓治疗比例增高,接受PPCI的患者比例减少,但出血风险及MACE没有增加。救治策略改变保证了STEMI患者的有效再灌注,没有对STEMI患者救治有效性和安全性产生不利影响。     

T lymphocytes and fractalkine contribute to myocardial ischemia/reperfusion injury in patients

BACKGROUND. Lymphocytes contribute to ischemia/reperfusion (I/R) injury in several organ systems, but their relevance in ST elevation myocardial infarction (STEMI) is unknown. Our goal was to characterize lymphocyte dynamics in individuals after primary percutaneous coronary intervention (PPCI), assess the prognostic relevance of these cells, and explore mechanisms of lymphocyte-associated injury.METHODS. Lymphocyte counts were retrospectively analyzed in 1,377 STEMI patients, and the prognostic relevance of post-PPCI lymphopenia was assessed by Cox proportional hazards regression. Blood from 59 prospectively recruited STEMI patients undergoing PPCI was sampled, and leukocyte subpopulations were quantified. Microvascular obstruction (MVO), a component of I/R injury, was assessed using MRI.RESULTS. In the retrospective cohort, lymphopenia was associated with a lower rate of survival at 3 years (82.8% vs. 96.3%, lowest vs. highest tertile; hazard ratio 2.42). In the prospective cohort, lymphocyte counts fell 90 minutes after reperfusion, primarily due to loss of T cells. CD8⁺ T cells decreased more than CD4⁺ T cells, and effector subsets exhibited the largest decline. The early decrease in effector T cell levels was greater in individuals that developed substantial MVO. The drop in T cell subsets correlated with expression of the fractalkine receptor CX3CR1 (r² = 0.99, P = 0.006). Serum fractalkine concentration peaked at 90 minutes after reperfusion, coinciding with the T cell count nadir.CONCLUSIONS. Lymphopenia following PPCI is associated with poor prognosis. Our data suggest that fractalkine contributes to lymphocyte shifts, which may influence development of MVO through the action of effector T cells.TRIAL REGISTRATION. Not applicable.FUNDING. British Heart Foundation (FS/12/31/29533) and National Institute of Health Research (NIHR) Newcastle Biomedical Research Centre.     

The use of hemodynamics to predict mortality in patients undergoing primary PCI for ST-elevation myocardial infarction

Introduction: Challenges remain in predicting mortality and severe myocardial dysfunction in patients undergoing primary percutaneous coronary intervention (PPCI) for ST elevation myocardial infarction (STEMI).

Areas covered: Cardiogenic shock is associated with a high mortality rate. Less well characterized are patients who are not in cardiogenic shock but will die from pump failure as a result of a STEMI. There is a long history of using hemodynamics to risk stratify patients with acute MI with the Killip class being shown to provide prognostic information in the prereperfusion, thrombolytic and PPCI eras. Recent studies have identified low systolic blood pressure (SBP), elevated heart rate, elevated left ventricular end diastolic pressure (LVEDP), and low SBP/LVEDP ratio as hemodynamic parameters associated with early mortality in patients undergoing PPCI. Although infrequently used, prognostic information can be obtained from right heart catheterization in the setting of STEMI with the best-studied parameters being cardiac power, pulmonary capillary wedge pressure (PCWP), cardiac output, right atrial pressure/PCWP ratio, and pulmonary artery pulsatility index.

Expert commentary: Hemodynamic parameters measured at the time of PPCI provide important prognostic information. Whether hemodynamics can be used to determine which patients benefit from early initiation of mechanical support remains to be determined.     

Contrast-enhanced cardiovascular magnetic resonance in the hyperacute phase of ST-elevation myocardial infarction

Cardiovascular magnetic resonance (CMR) very early after primary percutaneous coronary intervention (PPCI) may lead to instability or early stent complications. However, CMR in the hyperacute phase of STEMI may improve risk stratification. We investigated feasibility and safety of CMR in the hyperacute phase of STEMI immediately after PPCI. One hundred and twenty eight consecutive patients immediately after PPCI for STEMI. Sixty four underwent CMR <12 h after PPCI versus 64 matched controls. Outcomes were followed over 6 months. CMR in hyperacute STEMI was not associated with in-hospital death, infarct expansion, or urgent revascularization (P = NS). CMR (32 ml gadolinium contrast) immediately after PPCI (180 ml iodine contrast) did not increase nephropathy. CMR did not increase major adverse cardiac events (5 vs. 8%, P = 0.16) or recurrence of angina (6 vs. 8%, P = 0.73) at 6 months. CMR immediately after PPCI is feasible and safe, allowing very early risk stratification in STEMI. Dr. Larose is supported by the Heart and Stroke Foundation of Canada (Quebec) and the Quebec Heart Institute Foundation.     

Acute coronary syndrome: peri-interventional antithrombotic therapy

In patients with acute coronary syndrome (ACS), the periinterventional antithrombotic treatment has become increasingly important for the choice of reperfusion strategy and as an adjunct pharmacological treatment prior, during and after percutaneous coronary interventions (PCI). In NSTE-ACS and early invasive strategy (<48 h), treatment with ASA, clopidogrel and heparin - unfractionated heparin (UFH) preferred - should be initiated as soon as possible. Direct thrombin inhibitors are an alternative to heparin, particularly in the setting of increased risk of bleeding and heparin-induced thrombocytopenia. In highrisk patients, an so-called upstream therapy with glycoprotein IIb/IIIa inhibitors (tirofiban, eptifibatide) is recommended as an adjunct to PCI. In STEMI, primary PCI is the reperfusion therapy of choice and should be supported by early adjunct treatment with ASA, clopidogrel, UFH and glycoprotein IIb/IIIa inhibitors (abciximab, eptifibatide). "Facilitated" PCI with thrombolytics is not recommended because of increased mortality and complication rates.     

Barriers to the utilization of thrombolysis for acute ischaemic stroke

What is known and Objective: Thrombolysis is currently the only evidence‐based pharmacological treatment available for acute ischaemic stroke (AIS); however, its current utilization is suboptimal (administered to <3% of AIS patients). The aim of this article was to identify the potential barriers to the use of thrombolysis via a review of the available literature. Methods: Medline, Embase, International Pharmaceutical Abstracts and Google Scholar were searched to identify relevant original articles, review papers and other literature published in the period 1995–2011. Results and Discussion: Several barriers to the utilization of thrombolysis in stroke have been identified in the literature and can be broadly classified as ‘preadmission’ barriers and ‘post‐admission’ barriers. Preadmission barriers include patient and paramedic‐related factors leading to late patient presentation for treatment (i.e. outside the therapeutic time window for the administration of thrombolysis). Post‐admission barriers include in‐hospital factors, such as suboptimal triage of stroke patients and inefficient in‐hospital acute stroke care systems, a lack of appropriate infrastructure and expertise to administer thrombolysis, physician uncertainty in prescribing thrombolysis and difficulty in obtaining informed consent for thrombolysis. Suggested strategies to overcome these barriers include public awareness campaigns, prehospital triage by paramedics, hospital bypass protocols and prenotification systems, urgent stroke‐unit admission, on‐call multidisciplinary acute stroke teams, urgent neuroimaging protocols, telestroke interventions and risk‐assessment tools to aid physicians when considering thrombolysis. Additionally, greater pharmacists’ engagement is warranted to help identify the people at risk of stroke and support preventative strategies, and provide the public with information regarding the recognition of stroke, as well as facilitate the access and use of thrombolysis. What is new and Conclusion: The most effective interventions appear to be those comprising several strategies and those that target more than one barrier simultaneously. Therefore, optimal utilization of thrombolysis requires a systematic, integrated multidisciplinary approach across the continuum of acute care.     

The contemporary management of acute myocardial infarction.

The contemporary management of acute myocardial infarction continues to evolve rapidly. The ultimate goal of therapy is timely, complete, and sustained myocardial reperfusion. There is a powerful time-dependent effect on mortality, and thus the balance between the time and likelihood of maximal reperfusion is crucial in deciding whether to use primary percutaneous balloon angioplasty or thrombolysis as the initial reperfusion strategy. Newer thrombolytic agents allow for equivalent coronary reperfusion compared with the standard accelerated alteplase (tPA) regimen with the advantage of easier dosing regimens. Low molecular weight heparin has been shown to be superior to unfractionated heparin and likely will be the standard of care in the near future. The use of glycoprotein IIb/IIIa inhibitors has been shown to decrease the short- and long-term complication rates in patients with acute coronary syndromes treated medically and with percutaneous coronary interventions; however, the choice of the optimal agent and dosing regimen in various clinical settings remains controversial. Combination therapy with low-dose fibrinolytics, glycoprotein IIb/IIIa inhibitors, and low molecular weight heparin, with or without subsequent early planned percutaneous coronary interventions, may provide the optimal strategy for maximal coronary reperfusion, but the results of large, randomized mortality trials currently underway need to be analyzed. Risk stratification will continue to play a major role in determining which patients should receive a specific therapy. The care of the patient with an acute myocardial infarction will continue to be a challenge requiring the proper selection from the vast pharmaceutic and interventional options available.     

胸痛中心持续改进机制对急性心肌梗死患者行PPCI治疗的影响

目的 探讨胸痛中心持续改进机制对急性ST 段抬高型心肌梗死（STEMI）行直接经皮冠状动脉介入治疗 （PPCI）患者关键指标的影响。方法 2017年12月至2018年11月在我院行PPCI的急性 STEMI 患者90例，其中2017年12月至2018年5月46例为对照组，2018年6月至 2018年11月44例为观察组。比较两组的首份心电图获取时间、微信传输比例、绕行急诊和冠心病重症监护病房（CCU）比例、门球扩张（D to B）时间。结果 观察组首份心电图获取时间、D to B时间低于对照组（P<0.05）；观察组微信传输比例、绕行急诊和CCU比例高于对照组（P<0.05）。结论 胸痛中心持续改进可提高STEMI患者的微信传输比例、绕行急诊和CCU比例，缩短首份心电图获取时间、D to B时间，为STEMI患者进一步救治赢得时间。