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Vai trò của thời gian Thời gian bao gồm thời gian từ khi khởi phát triệu chứng chẩn đoán xác định, và để bắt đầu tan huyết. Ngoài ra, nó bao gồm khoảng thời gian chẩn đoán, bóng trong một thời gian bệnh viện hoặc chuyển PCI-có khả năng, mà cũng có thể bao gồm thời gian tổ chức chuyển giao cho đi bộ ở những bệnh nhân trong một bệnh viện không PCI-có khả năng, và khoảng thời gian doorto-bóng sau khi đến Úc tại trung tâm PCI | Role of timing Timing includes time from symptom onset to definitive diagnosis and to the start of thrombolysis. Alternatively it includes the diagnosis-to-balloon interval in a PCI-capable hospital or transfer time which may also include time to organise transfer for walk-in patients in a non-PCI-capable hospital and door-to-balloon interval after arrival at the PCI centre. When transferring a patient not only the capacities of the catheter laboratory and the intensive care unit in the target hospital have to be considered but also the capacity of the EMS especially in rural areas. Last but not least additional costs partially depending on the mode of transfer i.e. ground-bound or by helicopter have to be taken into account. The most important time factor when choosing optimal reperfusion treatment for an individual patient is the time delay between symptom onset and reperfusion of the myocardium at risk Fig 1 3 . The meta-analysis by Keeley 1 has to be criticised with regard to these timelines since the majority of the evaluated studies included patients with a symptom duration up to 12 hrs the SHOCK trial 4 even up to 36 hrs . Thrombolysis performed up to 12 hrs after symptom onset has proven to be effective 5 but is generally accepted only as a provisional therapeutic strategy later than 6 hrs after symptom onset. In other words with regard to the late 6-12-hr time window the results of the meta-analysis by Keeley 1 are in part a self-fulfilling prophecy. 100 80 60 40 20 C Extent of Myocardial salvage Shifts in potential outcomes with different treatment strategies A to B No benefit A to C Benefit B to C Benefit D to B Harm D to C Harm B A 0 I .I. 1 0 4 8 12 16 20 24 Time from symptom onset to reperfusion therapy hrs 1 Critical time-dependent period. Time-independent period. Goal myocardial salvage Goal open infarct-related artery Gersh BJ. JAMA 2005 293 979-986. JAMA. 2005 293 980 Copyright 2005 American Medical Association. All rights reserved. Figure 1 The .
