Analysis Of Continuous Improvement Of Chest Pain Center On Reperfusion Time And Short-term Prognosis Of Patients With Acute ST-segment Elevation Myocardial Infarction

Objective To analyze the influence of continuous improvement of emergency procedures in different departments on reperfusion and prognosis of patients with acute ST segment elevation myocardial infarction(STEMI)after chest pain center certification,and to explore the influencing factors of major cardiovascular adverse events(MACE)in patients with acute STEMI 30 days after percutaneous coronary intervention(PCI).Methods From March 2018 to July 2019,206 STEMI patients received percutaneous coronary intervention were selected from chest pain center of the first people’s hospital in Heifei.According to hospital visiting time,the patients were divided into 2 groups as Control group,n=98 and Study group,n=108.The general clinical data and coronary angiography results of the two groups were collected and analyzed,including age range,gender composition,smoking history,BMI,previous history(such as old myocardial infarction history,previous PCI history,etc.),Killip heart function classification at admission,culprit’s blood vessel condition and the number of implanted branches.We compared door to balloon time,first medical contact to balloon time,symptom onset to first medical contact time,total ischemia time and 30 days’ MACE after PCI between the two groups.The impact factors for 30-day MACE after PCI were studied by logistic regression analysis.Results No significant difference existed between the two groups in the general clinical data and emergency coronary angiography results.Compared with Control group,the following parameters were shortened in Study group: the finishing time of the first ECG [3(2,4)min vs 6(4,8)min,P<0.001],the finishing time of the first troponin [18(16,19)min vs 19(18,24)min,P<0.001],total ischemia time [205.0(159.8,307.0)min vs 241.0(199.0,329.0)min,P=0.005],the first medical contact-to-balloon time[84.5(73.0,96.0)min vs 112.0(93.0,132.5)min,P<0.001],door-to-balloon time[72.5(58.3,83.8)min vs 78.0(68.0,96.5)min,P=0.038].These differences are statistically significant.Symptom onset to first medical contact time was lower in the study group[124.5(77.3,201.0)min vs 130.0(76.3,216.0)min,P>0.05],but there were no significant difference between the two groups.The ratio of 30-day MACE after PCI in Study group were lower than Control group(16.7% vs 28.6%,P=0.040),significant difference was found between the two groups.According to the results of multivariate logistic regression analysis,Killip class Ⅲ~Ⅳ(OR 2.618,95% CI 1.244~5.509,P=0.011),door-to-balloon time>60 min(OR 2.227,95% CI 1.087~4.563,P=0.029)and symptom onset to first medical contact time > 90min(OR4.562,95% CI2.167~9.603,P<0.001)were independently associated with 30-day MACE after PCI.Conclusions The progressive improvement of the chest pain center may promote the rational use of medical resources in the region,effectively shorten the length of hospital stay and treatment time for patients with STEMI,and reduce the financial burden on patients,and reduce 30-day MACE after PCI.