| Objective: To investigate the treatment status and short-term prognosis of patients with acute ST elevation myocardial infarction(STEMI)in Jining city under the existing national chest pain center management methods and treatment mode,and to provide clinical evidence-based medicine basis for establishing a more perfect and optimized chest pain center regional collaborative treatment system.Methods: A total of 962 patients who were diagnosed with acute ST elevation myocardial infarction(STEMI)and received emergency percutaneous coronary intervention(PCI)in the Jining First People’s Hospital from July 1,2018 to June 30,2022 were enrolled and divided into group A,group B,group C and group D according to the admission time.From July 1,2018 to June 30,2019,213 patients were included in group A,205 patients were included in group B from July 1,2019 to June 30,2020,263 patients were included in group C from July 1,2020 to June 30,2021,and 281 patients were included in group D from July 1,2021 to June30,2022.The general clinical data,symptom-to-first medical contact time(S2FMC),door-in to door-out time(DIDO),door-to-balloon time(D2B),first medical contact-to-balloon time(FMC2B),symptom-toballoon time(S2B),incidence of in-hospital major cardiovascular adverse events(MACEs),and in-hospital mortality were compared between S2 B time and S2 FMC time,DIDO time,D2 B time,and FMC2 B time,the effect of different hospital visits on the treatment time was compared,and the risk factors of in-hospital MACEs and in-hospital death were analyzed.Results: There was no significant difference in gender,age,heart rate,systolic blood pressure,diastolic blood pressure,proportion of Killip≥grade 2,smoking history,hypertension history,diabetes history,coronary heart disease history,PCI history,infarct related artery(IRA)distribution,TIMI grade 0 proportion,thrombus aspiration proportion,proportion of temporary pacemaker implantation,proportion of intra-aortic balloon pump(IABP),and length of hospital stay among the four groups(P>0.05),and the average hospitalization costs generally showed a decreasing trend(P<0.05).The median time of S2 FMC,DIDO,D2 B,FMC2B and S2 B in all selected patients was 125 min,40 min,73 min,87 min and 246 min,respectively,and the median time of FMC2 B and DIDO showed a decreasing trend(P<0.001),while the median time of S2 B,S2FMC and D2 B did not change significantly(P>0.05).S2 FMC,DIDO,D2 B,and FMC2 B times were all positively correlated with S2 B time(r=0.866,P<0.001;r=0.377,P<0.001;r=0.211,P<0.001;r=0.456,P<0.001),with S2 FMC time having the strongest correlation with S2 B time.Patients came to the hospital on their own after onset(60.40%),while calling 120 came to the hospital(14.76%).The median time of S2 FMC,FMC2B,D2 B and S2 B was not exactly the same in patients who came to the hospital in different ways(P<0.05),and there was no significant difference in the median time of S2 FMC among patients who came to the hospital in three different ways(adjusted P>0.05);the median time of FMC2 B was increased in patients who called 120 came to the hospital and transferred to the hospital compared with patients who came to the hospital spontaneously(102.5 min:75 min;165 min:75 min;adjusted P<0.001),and the median time of D2 B was decreased in patients who called 120 came to the hospital and transferred to the hospital compared with patients who came to the hospital spontaneously(67 min: 76 min;67 min: 76 min;adjusted P<0.001);the median time of S2 B was decreased in patients who came to the hospital and called 120 came to the hospital compared with the median time of S2 B in patients who came to the hospital(219 min:303 min;233.5 min:303 min;adjusted P<0.001).The incidence of MACEs in STEMI patients during the whole time period was 13.41%,with a significant decreasing trend(P<0.001).The incidence of in-hospital death in STEMI patients during the whole time period was 4.05%,which tended to decrease significantly(P=0.021).Patient age,systolic blood pressure,Killip≥2,TIMI 0,temporary pacemaker placement,and IABP had a statistically significant effect on in-hospital MACEs(OR=1.045,95% CI1.025–1.065;OR=0.977,95% CI 0.993–1.017;OR=4.572,95% CI 2.940–7.109;OR=1.966,95% CI 1.139–3.393;OR=6.808,95% CI 1.551–29.880;OR=4.610,95% CI 1.531–13.887;P<0.05).Patient age,systolic blood pressure,Killip≥2,TIMI 0,and temporary pacemaker placement had a statistically significant effect on in-hospital death(OR=1.059,95% CI1.024–1.096;OR=0.964,95% CI 0.938–0.991;OR=5.644,95% CI 2.672–11.924;OR=4.356,95% CI 1.199–15.826;OR=9.724,95% CI 1.200–78.778;P<0.05).The effect of S2 FMC time on the occurrence of MACEs in the hospital was statistically significant(OR=1.001,95% CI 1.000–1.002,P<0.05).The effect of S2 FMC time and DIDO time on in-hospital death was statistically significant(OR=1.002,95% CI 1.001–1.004;OR=1.005,95% CI 1.000–1.009;P<0.05).Conclusion:The establishment of chest pain center regional collaborative rescue system can shorten the treatment time in the medical system,reduce the referral delay,and reduce the incidence of in-hospital major adverse cardiovascular events and in-hospital mortality of patients with acute ST elevation myocardial infarction.The S2 FMC time is the strongest correlation with the total ischemic time,and it is an important factor to predict the occurrence of in-hospital adverse events in patients with STEMI. |
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