Impact Of The Interactive Discipline Alliance On Prognosis Of Patients With Acute ST-segment Elevation Myocardial Infarction

Objective:To evaluate if the interactive discipline alliance can improve the prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI)by comparison and analysis the differences of clinical situaion of the patiants from chest pain center of Chengdu Third People’s Hospital before and after the establishment of the interactive discipline alliance,that may provide some reference for the construction of the alliance.Methods: We take January 1st,2018 that the allinace was officially established and operated as the time point,collect the clinical datas of STEMI patients who was transfered to the chest pain center of Chengdu Third People’s Hospital and took emergency percutaneous coronary intervention(PCI)from January 2017 to December 2018 through consult the record of chest pain center and medical records system and analyzed the datas retrospectively.The datas included gender,age,smoking history,anamnesis,and evaluate the clinical situation of patients,then compare and make a statistical analysis of the time of symptom to door(S2D),door to balloon(D2B),symptom to balloon(S2B),symptom to first medicial contact(S2FMC),first medicial contact to balloon(FMC2B),first medicial contact to electrocardiogram(FMC2ECG),ratio of ECG transfered,ratio of transfered to the cath lab,non-PCI hospital door in door out(DIDO),inpatient days,costs,prognosis.Results:We selected patients with actue STEMI who was transfered to the chest pain center and took emergency PCI according to the inclusion and exclusion criteriain,85 cases in total.Patients transfered through the medical alliance in 2017 were included in control group,and patients transfered through the discipline alliance in 2018 were included in observation group.The control group,including 26 males(74.3%)and 9 females(25.7%),35 cases in total.The age ranged from 46 to 87,and the average age was 68.29±11.40 years old.The observation group,including 40 males(80.0%)and 10 females(20.0%),50 cases in total.The age ranged from 42 to 90,and the average age was 64.58±12.47 years old.There was no statistically significant difference in gender,age,somking history,medical insurance and anamnesis between two groups(P>0.05).TThere was no statistically significant difference in complication,results of CAG,treament between two groups(P>0.05).For the control group,S2 D 185(115)min,D2 B 95(46)min,good control rate 45.7%,S2B282(184)min,S2 FMC 61(68)min,good control rate77.1%,FMC2 B 210(65)min,FMC2ECG6(27)min,good control rate 77.1%,ratio of ECG transfered 42.8%,antiplatelet agents43(63)min,good control rate 17.1%,ratio of antiplatelet agents before transfer 65.7%,DIDO101(69)min,ratio of transfered to the cath lab 11.4%,ratio of MACE 34.3%.For the observation group,S2 D 167(165)min,D2 B 80(53)min,good control rate 64.0%,S2B260(178)min,S2 FMC 78(95)min,good control rate 86.0%,FMC2 B 170(120)min,FMC2 ECG 3(4)min,good control rate 96.0%,ratio of ECG transfered 74%,antiplatelet agents 15(35)min,good control rate 42.0%,ratio of antiplatelet agents before transfer78.0%,DIDO 39(65)min,ratio of transfered to the cath lab 36.0%,,ratio of MACE 20.0%.There was statistically significant difference in S2 B,FMC2B,FMC2 ECG,FMC2ECG good control rate,ratio of ECG transfered,antiplatelet agents,good control rate,DIDO,ratio of transfered to the cath lab between two groups(P<0.05),and no statistically significant difference in others(P>0.05).The inpatient days of control group was 9(4)days,costs was52758(26218)yuan.The inpatient days of observation group was 10(5)days,costs was45537(16049)yuan.There was no statistically significant difference in inpatient days,costs and prognosis of two groups.Compared with the control group,the ratio of MACE of observation group had decreasing trend,but there was no statistically significant differencein(P<0.05).Conclusion: The interactive discipline alliance can significantly improve the ability of primary hospitals of diagnosing and treating for STEMI,reducing the time of myocardial ischemia.But limited by time,it needs more time to observe if its impact for patients’ futhur prognosis.