Outcomes by Day and Night for Patients Bypassing the Emergency Department Presenting with ST‐Segment Elevation Myocardial Infarction Identified with a Pre‐Hospital Electrocardiogram

Background

Pre‐hospital ECG and emergency department (ED) bypass direct to the catheter laboratory may optimize reperfusion times for patients with ST‐segment elevation myocardial infarction. Questions remain over feasibility and safety during off hours.

Aims

To determine if presenting time of day is associated with differences in in‐hospital and 30‐day mortality and key reperfusion times.

Methods/Results

Seven hundred and twenty consecutive patients with STEMI triaged directly from the field to the catheter laboratory between June 2004–May 2013. Vital status was reported as of August 2013. The mean age was 65 ± 14 years, and 75.1% were male. Overall mortality (in‐hospital/30 days) did not significantly differ for patients (3.4% in hours and 3.1% off hours; P = N/S). Symptom onset‐to‐arrival to the heart attack was non‐significantly lower (100 minutes off hours (IQR 78–174) versus 110 minutes in hours (IQR 75–199), P = N/S). Call‐to‐balloon time was not significantly affected by the time of presentation: 150 min in hours (IQR 111–239) versus 154 minutes during off hours (IQR 115–225) P = N/S. Overall door‐to‐balloon time was 36 minutes (IQR 25–51), 34 minutes in hours (IQR 24–49) versus 40 minutes off hours (IQR 29–55) P = N/S. The overall false positive activation rate was only 13.1%, (in hours 12.2% vs. off hours 14.6%, respectively, P = N/S).

Conclusions

In a unit with an established field triage system facilitating ED bypass, reperfusion times and mortality are not significantly influenced by whether the patient presents during standard working hours or outside of these hours. (J Interven Cardiol 2015;28:24–31)

     

百日咳:可于任何年龄段发病的疾病

百日咳杆菌是具有高度传染性的革兰阴性杆菌，通过空气播散、飞沫传播，只有人类可感染该病原菌而发病。该菌所产生的抗原物质既可引起局部细胞损害，又可引起全身反应。     

Malignant peripheral nerve sheath tumor of the kidney

Malignant peripheral nerve sheath tumors are rare in the genitourinary organs, with few reports of occurrence in the kidney. We describe a patient with a renal malignant peripheral nerve sheath tumor, discovered after excision of a malignant peripheral nerve sheath scalp lesion, with additional masses in the lung and shoulder on metastatic evaluation. This patient underwent neoadjuvant intravenous doxorubicin therapy, followed by surgical resection of the scalp, lung and shoulder lesions in addition to a radical nephrectomy.