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응급의료서비스 이용 유무에 따른 급성 심근경색증 환자의 1년간 주요 심뇌혈관사건 발생 비교

Comparison of major cardiac and cerebrovascular events in patients with acute myocardial infarction according to the use of emergency medical service during one-year clinical follow-up

대한응급의학회지 2020년 31권 2호 p.181 ~ 190
김수진 ( Kim Su-Jin ) - Chonnam National University Hospital The Heart Center

이은숙 ( Lee Eun-Sook ) - Chonnam National University Department of Nursing
정명호 ( Jeong Myung-Ho ) - Chonnam National University Hospital The Heart Center
김민철 ( Kim Min-Chul ) - Chonnam National University Hospital The Heart Center
심두선 ( Sim Doo-Sun ) - Chonnam National University Hospital The Heart Center
홍영준 ( Hong Young-Joon ) - Chonnam National University Hospital The Heart Center
김주한 ( Kim Ju-Han ) - Chonnam National University Hospital The Heart Center
안영근 ( Ahn Young-Keun ) - Chonnam National University Hospital The Heart Center
조명찬 ( Cho Myeong-Chan ) - Chungbuk National University Hospital Department of Cardiology
김종진 ( Kim Chong-Jin ) - Kyung Hee University Hospital Department of Cardiology
김영조 ( Kim Young-Jo ) - Yeungnam University Hospital Department of Cardiology

Abstract


Objective: The emergency medical service (EMS) is expected to improve the prognosis of patients suffering from acute myocardial infarction (AMI). We investigated the impact of utilizing EMS on the clinical outcomes of AMI patients.

Method: From November 2011 to November 2015, a total of 13,102 patients in the Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH) registry were enrolled. Patients were divided into two groups: the EMS group, first medical contact (FMC) with 119; the non-EMS group, the FMC at local hospitals that were not available for percutaneous coronary intervention. The authors analyzed the mortality and major adverse cardiac and cerebrovascular events during one-year of clinical follow-up.

Results: A total of 8,863 patients were finally analyzed for this study, and a total of 1,999 patients (22.6%) utilized the EMS as FMC. The patients utilizing EMS were more frequently diagnosed with ST-segment elevation AMI. At presentation, the EMS group had a higher incidence of Killip class IV, and they had a shorter symptom-to-door time than nonEMS group. The patients utilizing EMS had higher incidence of peri-procedural complications and in-hospital mortality. The multivariate logistic regression analysis with backward elimination revealed that utilizing EMS is an independent factor for predicting lower one-year mortality.

Conclusion: This study has demonstrated that the high-risk AMI patients can utilize the EMS in Korea. The EMS group has more favorable clinical outcome during one-year follow-up after discharge than the non-EMS group, whereas it had a higher rate of death during hospitalization compared with that of the non-EMS group.

키워드

Emergency medical service; Myocardial infarction; Mortality
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