The Influences Of Chest Pain Center Establishment On Treatment Of Patients With Acute ST-segment Elevation Myocardial Infarction

Objective: This study was to explore the influences of chest pain center establishment on treatment of patients with acute STEMI: 1.to assess whether the chest pain center establishment can reduce total ischemic time and in-hospital major adverse cardiovascular events among acute ST-segment elevation myocardial infarction;2.to compare the hospitalization duration and expenditent in the both groups.Methods: A consecutive acute STEMI patients within 12 hours from to symptom onset were screened,who were admitted in the second hospital of Tianjin medical university between October 1,2015 and November 31,2016.The inclusion criteria were: 1.duration from symptom onset to FMC was less than 12 hours;2.the ST segment elevation at least 2 contiguous leads of ≥ 0.2 mm(0.2m V)in chest leads or of ≥ 0.1 mm(0.1m V)in limb lead or new left bundle branch block;the myocardial biomarkers(cardiac troponin,CTn)higher than a reference standard.The exclusion criteria: allergy to aspirin,ticagrelor,clopidogrel or heparin.According to the chest pain center establishment in June 1,2016,all patients were divided into the group after the chest pain center establishment(late group)and the group before the chest pain center establishment(early group).All included patients were collected basic information with STEMI,which includes date of hospital visiting,age,sex,onset time,time of reach the door,hospital approach,history of hypertension,past history,exposure to antiplatelet drugs or anticoagulant and so on.All patients were treated according to the Acute STEMI Diagnosis and Treatment Guidelines in 2015.Primary PCI was first performace method.If the D-to-B less than 90 min,the thrombolysis is able to implement.The performance of chest pain center procedures CCU or emergency room was encouraged to reduce D-to-B duration,absence to beforeprimary PCI,the anti-platelet drugs and heparin were administered in after the diagnosed of acute STEMI.The time nodes were collected to Door-double dual antiplatelet therapy(D-DAPT);Door-Heparin(D-H);Door-to-Balloon(D-to-B);Symptom onset to Door(SO-D);and total ischemia time.The global coronary lesions were evaluated according to coronary angiography(CAG),and were recorded in culprit lesion vessels and degree,collateral circulation,Chronic total occlusion(CTO),preoperative TIMI blood flow,thrombosis,thrombus staining,interventional program;the results of PCI includes postoperative TIMI blood flow,stenting and its length.The major adverse cardiovascular events(MACE)in patients during hospitalization,the MACE as defining as a complex of clinical adverse cardiovascular events,including acute heart failure,fatal and nonfatal stroke,malignant arrhythmia,angina pectoris recurrence,cardiac death;and Echocardiography including the size of left atrial,left ventricular and left ventricular ejection fraction were recorded.At the same time,the average of in-hospital duration and expenditure were recorded.Results: 1.According to blood collections after admission,compare with the early group,the late group was lower in total white blood cells,absolute monocyte,neutrophilic granulocyte percentage,postoperative CK-MB and hs-CRP(p<0.05).2.Compared with the Killip classes,there was more patients in the early group with Killip class Ⅲ/Ⅳ(10.4% vs.23.6 %,P=0.006).The level of NT-pro BNP was more patients in the early group(80.4(6.0,476.5)vs.18.3(5.0,128.4),P=0.012).According to Doppler echocardiography,the late group was higher in left ventricular ejection fraction(LVEF)(52.58±9.38 vs.22.38±7.79,P=0.029).3.249 patients underwent coronary angiography in this study with 120 cases inthe early group and 129 cases in the late group,the remaining 25 patients did not accept primary PCI because they refused to carry out reperfusion therapy or the occurrence of the MACE.Compared with the early group,the proportion of reperfusion before intervention treatment was higher(41.1% vs.25.8 %,P=0.016)in the late group.Compared with TIMI thrombus grade,there was more patients with grade 1、2 in the late group(27.9% vs.16.7%,P=0.048;9.3% vs.1.7%,P=0.011,and less patients with grade 5 in the late group(55.5% vs.69.2%,P=0.036).4.Compared with the early group,the late group had significantly shorter in DDAPT(15.53±14.15 vs.45.11±36.98,P<0.001,D-to-B(80.15±31.74 vs.154.52±50.68,P<0.001)、D-H(29.50±27.04 vs.138.40±84.92,P<0.001)、SODoor(45(90.0,241.0)vs.210.0(122.25,309.75,P=0.004)and total ischemia time(266.21±224.31 vs.412.69±241.04,P<0.001).5.In the comparison of in-hospital MACE,there was more patients in the early group(24.3% vs.12.7%,P=0.019.As to components of MACE,the proportion of acute heart failure(19.3% vs.9.7%,P=0.029,cardiac death(10.0% vs.3.0%,P=0.02)was higher in the early group.6.Predictors of MACE were analyzed by multiple logistic regression,which showed that D-to-B、SO-Door and total ischemia time were independent risk factors of in-hospital MACE.7.The ROC curve analysis showed D-to-B、SO-Door and total ischemia time could be as a predictor of in-hospital MACE in patients with STEMI(P<0.05).8.In terms of in-hospital duration and expenditure,in-hospital duration of the late group was 6.08 ± 1.96,compare to 7.60 ± 4.50 in in the early group,an average shorten of 20%;and the expenditure of the early group was 43517 ± 23195 ￥,compare to 35716 ± 13465 ￥ in in the late group,an average reduction of 17.9%.Conclusion: 1.According to the time nodes of the chest pain center establishment,the late group had significantly shorter time of D-DAPT,D-H,D-to-B,SO-Door and total ischemia time;furthermore,the proportion of reperfusion before PCI was higher and TIMI thrombus load was significantly lower.2.The in-hospital MACE were significantly lower in the late group than that of early group.As to components of MACE.And D-to-B,SO-Door and the total ischemia time were independent risk factors of in-hospital MACE.3.The average of in-hospital duration and expenditure were significantly lower since the chest pain center establishment.