| Objective: In recent years,chest pain centers(CPCs)have been actively constructed in China,and has achieved great achievements.The regional cooperative network based on CPCs has also been gradually developed and optimized.Previous studies showed that regional cooperative networks improved the treatment efficiency of ST-segment elevation myocardial infarction(STEMI)and non-ST-segment elevation myocardial infarction(NSTEMI),but there was no consistent result on whether it improved the prognosis of patients.This was a multicenter study that retrospectively analyzed the effects of regional cooperative networks on reperfusion time,treatment effect during hospitalization,and prognosis in 6 months after discharge in AMI patients.Methods:1.Screening hospitalsThe hospitals selected for the inclusion of patients should have the following criteria:(1)It had established a chest pain center;(2)It had a primary percutaneous coronary intervention(PPCI)capability;(3)It had established a regional cooperative network with other surrounding facilities;(4)It agreed to participate in this study and provide patients’ information used only for this study.Finally,eight tertiary general hospitals located in different locations in Chengdu were included.From January to December 2018,regional cooperative networks with eight hospitals as centers had been gradually built and improved.2.Inclusion of patients,collection of data,and follow-upA total of 1937 AMI patients who admitted at above 8 hospitals from July 2017 to June2019 were enrolled.Patients’ data were collected from the electronic case systems of 8hospitals with consent.1235 AMI patients were followed up through the phone and their data were collected within 6 months after discharge.3.Reperfusion time and clinical outcomes(1)Timeliness of treatment(1)The primary indicators: SO-to-FMC time,SO-to-D time,D-to-B time,FMC-to-B time and SO-to-B time for STEMI patients underwent PPCI.(2)The Secondary indicator: the interval from the time of arriving door to the time of undergoing PCI for NSTEMI patients.(2)Treatment effect during hospitalization(1)The primary indicator: all-cause death during hospitalization.(2)The Secondary indicators: incidence of Left ventricular ejection fraction(LVEF)<50%,incidence of the ventricular aneurysm,and incidence of regional wall motion abnormalities.(3)Prognosis in 6 months after discharge(1)The primary indicators: incidence of major adverse cardiovascular and cerebrovascular events(MACCE)and all-cause death.(2)The Secondary indicators: myocardial infarction(MI),revascularization,and stroke.4.Statistical analysisThe midpoint time of supervising the construction of the system(June 30,2018)was the boundary of grouping.All patients with AMI were divided into A group(admitted to hospital from July 2017 to June 2018,n=876)and B group(admitted to hospital from July 2018 to June 2019,n=1061)according to the time of admission.Baseline characteristics,timeliness of treatment,treatment effects during hospitalization,and 6-month prognosis were compared between the two groups.The case-fatality rate during hospitalization was compared between two groups,and confounding factors for in-hospital death were analyzed by multivariate Logistic regression analysis.Subgroup analysis of the case-fatality rate during hospitalization was performed through a multivariate Logistic regression model analysis.The cumulative incidence of MACCE and death in 6 months after discharge were expressed by the Kaplan–Meier curve,and statistical differences between the groups were performed with the Log-rank test.Cox proportional hazard ratio model analysis was used to assess the HR of the B group compared to A group.Results:1.Comparison of clinical baseline characteristicsHistory of stroke was less,but systolic blood pressure was lower,proportions of non-sinus rhythm and multi-vessel disease were higher in B group than those in A group(P<0.05).There was no statistically significant difference in other clinical baseline characteristics between the two groups(P>0.05).2.Comparison of timeliness of treatmentAmong STEMI patients performed with PPCI,D-to-B time [73(50,103)min vs.87(55,119)min,P<0.05] was significantly shorter,and the proportions of FMC-to-B time(50.4%vs.40.7%,P<0.05)and D-to-B time(70.2% vs.56.7%,P<0.05)within guideline recommendations were significantly higher in B group than those in the control group;there was no statistically significant difference in SO-to-B time,SO-to-FMC time,SO-to-D time,and FMC-to-B time between the two group(P>0.05).There was no significant difference in the interval from the time of arriving door to the time of undergoing PCI for NSTEMI patients treated PCI treatment between the two groups(P>0.05).3.Comparison of short-term prognosis in the hospital(1)All-cause death during hospitalizationThe in-hospital case-fatality rate of patients with AMI in B group was statistically lower than that in the A group(5.5% vs.8.0%,P=0.026).Multivariate Logistic regression analysis result showed that,risk of death during hospitalization in B group was still significantly lower [OR=0.614,95% CI(0.411,0.918),P=0.017].Subgroup analysis showed that,In-hospital case-fatality rate of patients was statistically significantly lower in B group than that in A group among patients with younger age(<70years),male,STEMI,diabetes mellitus,hypertension,KILLIP 1 grade,single-vessel disease,admission by transferring,admission at nighttime.However,the decrease of case-fatality rate was not significant in other subgroups.(2)Cardiac functionThe proportion of patients with LVEF<50%(17.5% vs.27.4%,P<0.05)and incidence of regional wall motion abnormalities(29.5% vs.41.6%,P<0.05)in B group were statistically significantly lower than those in A group.Although the incidence of ventricular aneurysm(2.2% vs.3.7%)in group B was lower than that in the A group,there was no significant difference.4.The prognosis for 6 months after discharge(1)MACCEThere was no significant difference in the incidence of MACCE between the two groups at 6 months after discharge(8.9% vs.7.9%,P>0.05),and multivariate Logistic regression analysis showed that there was no statistically significant difference between the two groups[OR=1.124,95%CI(0.731,1.730),P=0.594].The Log-rank test showed that there was no significant difference in the incidence of MACCE in 6 months between the two groups(P>0.05),and the difference was still not significant after analyzing confounding factors by multivariate Cox regression model [OR=1.089,95%CI(0.734,1.750),P=0.394].(2)All-cause deathThere was no significant difference in the incidence of death between the two groups at 6months after discharge(5.9% vs.5.9%,P>0.05),and multivariate Logistic regression analysis showed that there was no statistically significant difference between the two groups[OR=0.957,95%CI(0.571,1.603),P>0.05].The Log-rank test showed that there was no significant difference in the rate of death in 6 months between the two groups(P>0.05),and the difference was still not significant after analyzing confounding factors by multivariate Cox regression model [OR=0.935,95%CI(0.584,1.497),P=0.781].(3)MIThere was no significant difference in the incidence of myocardial infarction in 6 months after discharge between the two groups of patients(B group: 0.4%,A group: 0.4%,P>0.05).(4)RevascularizationThere was no significant difference in the incidence of revascularization in 6 months after discharge between the two groups of patients(B group: 2.9%,A group: 1.8%,P>0.05).(5)StrokeThere was no significant difference in the rate of stroke in 6 months after discharge between the two groups of patients(B group: 1.7%,A group: 1.7%,P>0.05).Conclusions: In STEMI patients performed emergency PCI,the gradual improvement of the regional cooperative network is helpful to reduce in-hospital delay and improve the proportions of FMC-to-B time and D-to-B time within guideline recommendations,but it has no significant effect on shortening SO-to-FMC time and SO-to-B time.The improvement of the system is significantly conducive to the reduction of the in-hospital death and the improvement of cardiac function for AMI patients,but not the improvement of prognosis in6-month. |
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