| OBJECTIVE:Atherosclerotic cardiovascular disease(ASCVD)has become the leading cause of death worldwide.Acute ST-segment elevation myocardial infarction(STEMI)is the most severe type of ASCVD,accounts for one quarter of ASCVD deaths.STEMI is deined as myocardial necrosis due to severe and persistent ischemia in the coronary artery supply area.In order to reduce the mortality of STEMI patients,timely opening of infarct-related arteries,namely reperfusion therapy,is the main means of treatment.STEMI diagnosis and treatment guidelines(2019)emphasize Reducing the total time of myocardial ischemia to maximize reperfusion efficiency to reduce mortality.The ideal is rich,but achieving this goal in clinical practice is extremely challenging.Current measures such as prehospital thrombolysis,prehospital emergency care,and chest pain centers greatly reduce the time from onset to vessel opening and improve reperfusion efficiency.The 2019 China Cardiovascular Report notes that although the total number of interventions in STEMI patients is increasing year by year,the overall incidence of mortality and adverse cardiovascular events has not decreased,and the therapeutic inflection point cardiovascular physicians expect has still not occurred.How to implement reperfusion treatment options for patients as early as possible still needs to be explored.The purpose of this study is to analyze the time to diagnosis and treatment of STEMI patients,i.e.,the time from onset to consultation and the time from admission to balloon dilation;and to analyze the factors influencing the delay in consultation and the occurrence of serious cardiovascular events in STEMI patients,so as to optimize the process and continuous improvement in order to effectively promote the standardized management of chest pain centers.METHODS:The clinical data of 768 STEMI patients who met the inclusion criteria enrolled in HUAIHE Hospital of Henan University from January 2016 to October 2020 were retrospectively analyzed.1.Patients were divided into delayed visit group(>6 hours)and timely visit group(≤6 hours)according to the time from onset to arrival at our hospital,and the baseline characteristics between the two groups were observed and the factors associated with delayed visit were analyzed.2.The time to dilatation and the percentage of attainment(≤90 minutes)were analyzed to assess the level of our hospital and to summarize the strengths and weaknesses.3.Patients were divided into good prognosis group and poor prognosis group according to whether they had serious cardiovascular events during hospitalization,and the clinical baseline characteristics and coronary lesions between the two groups were compared to analyze the factors influencing the occurrence of poor prognosis.Logistic regression analysis was used to explore the risk factors for inhospital serious cardiovascular events in these patients and factors associated with delayed access to the clinic.Statistical analysis was performed using SPSS25.0 software.p < 0.05 was statistically significant.RESULTS:1.There were 560 cases(72.92%)from admission to balloon dilation ≤90 minutes in our STEMI patients;>90 minutes accounted for 27.08%.Good prognosis group: admission to balloon dilatation time84.76±37.95 minutes;poor prognosis group: 102.38±47.17 minutes.In-hospital occurrence of serious cardiovascular events accounted for 11.98% of the total number.2.Analysis of the time to visit STEMI patients revealed that the two groups were statistically different in age,no previous angina,non-working day visit,stroke,hypertension,diabetes,smoking,emergency admission,first visit to our hospital,and atypical symptoms(P < 0.05);age,no previous angina,stroke,hypertension,diabetes,emergency admission,first visit to our hospital,and atypical symptoms were the independent influencing factors.The prognosis of STEMI patients was found to be statistically different between the two groups in terms of age,sex,no previous history of angina,non-working day visits,stroke,hypertension,diabetes,smoking,emergency admission,first visit to our hospital,atypical symptoms,time from admission to balloon dilation,and coronary lesions(P < 0.05);age,no previous history of angina,non-working day visits,stroke,diabetes,smoking Age,no previous history of angina,non-working day visit,stroke,diabetes mellitus,smoking,emergency admission,first visit to our hospital,atypical symptoms,time from admission to balloon dilation,and coronary artery disease were independent influencing factors for in-hospital presentation of serious cardiovascular events.4.Hematological analysis showed that LDL cholesterol had a statistically significant difference on the prognosis of STEMI patients(P < 0.05);platelets,leukocytes,neutrophils,lymphocytes,hemoglobin,creatinine,glutathione,glutathione,total protein,albumin,total cholesterol,and triglycerides did not have a statistically significant effect on the delay in presentation and the occurrence of in-hospital serious cardiovascular events(P > 0.05).CONCLUSION:1.The time from admission to balloon dilation and the proportion of patients with STEMI(the time from admission to balloon dilation≤90 minutes)in our hospital are basically consistent with the relevant reports in China,but there is still a certain gap with some European and American countries.2.Age,absence of previous history of angina,stroke,and diabetes are risk factors for delayed consultation and in-hospital serious cardiovascular events in patients with STEMI.Urgent care and first visit to a hospital with PCI can reduce the delay in treatment,the occurrence of serious cardiovascular events,and mortality. |
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