The Influence And Evaluation Of The Effect Of PCI Guideline To The Strategy For Acs Diagnosis And Treatment In Practical Field

Background and Objectives:Objective of implementing Percutaneous Coronary Intervention(PCI)guideline(2009)in China is to shorten the gap between professional knowledge,standard diagnosis and treatment behavior of doctors by which to get more benefits for patients.However,there are few reports about the degree of doctors that concern in understanding,accepting and putting the guidelines into practice.This study was to retrospectively analyze the implementation of PCI treatment in acute coronary syndrome(ACS)patients in the First Affiliated Hospital of Guangxi Medical University.According to the indication of Guidelines on PCI(2009),we evaluate the influence of the PCI guideline(2009)to the strategy for ACS diagnosis and its curative effect in Class IA patients.Methods:In this study,we selected Class IA ACS patients according to the indication of Guidelines on PCI(2009)from2009to2010in the First Affiliated Hospital of Guangxi Medical University.First,we wanted to know how many patients accepted PCI within the given time according to the compliance requirements in the PCI guideline(2009).All the selected patients were divided into guideline group and non-guideline group.The guideline group included the patients who accepted PCI within the given time according to the compliance requirements of the PCI guideline(2009)where The non-guideline group is the opposite.Nextly,we wanted to know whether the patients who accepted PCI within the given time according to the compliance requirements in the PCI guideline(2009)could get more benefits.All the selected patients were divided into STEMI patients and UA/NSTEMI patients according to the different character of the ST segments.Due to the given different treatment strategies,STEMI was subdivided into primary PCI group,elective PCI group and drug group whereas UA/NSTEMI was subdivided into early PCI group,elective PCI group,extension PCI group and conservative group.We followed all the selected patients at3-month and1year,observed the incidence of the major adverse cardiac events in cardiovascular system(recurrent angina,cardiac death,myocardial re-infarction and heart failure)and re-admission for analyzing the influence of the different strategies to the different types of ACS.Results:We selected2896coronary heart disease patients,including1747ACS patients and468Class IA ACS patients according to the indication of Guidelines on PCI(2009)were enrolled,of which170(36.32%)cases were in guideline group(31STEMI and139UA/NSTEMI)and298(63.68%)were in non-guideline group(46STEMI and252UA/NSTEMI).There were77cases of STEMI,including31in the primary PCI group,30in the elective PCI group and16in the drug group.Whereas391cases of UA/NSTEMI,including139in the early PCI group,121in the elective PCI group,51in the extension PCI group and80in the conservative group.Mean of age(guideline group61.74±10.48years versus non-guideline group63.94±11.77years, P=0.045),mean of hospitalization period(9.24±5.63days vs.11.44±5.63days,P=0.000).MACE at3months:guideline group22.35%versus non-guideline group34.56%,P=0.006;primary PCI group22.58%vs.non-primary PCI group45.65%, P=0.039;primary PCI group22.58%vs.drug group62.5%,P=0.007; early PCI group22.30%vs.non-early PCI group32.54%,P=0.033; early PCI group22.30%vs.extension PCI group37.25%,P=0.038;early PCI group22.30%vs.conservative group46.25%,P=0.000.Recurrence of angina at3months:guideline group17.65%versus non-guideline group27.52%,P=0.016;primary PCI group12.90%vs.non-primary PCI group32.61%, P=0.049;primary PCI group12.90%vs.drug group50.00%,P=0.006; early PCI group18.71%vs.extension PCI group33.33%,P=0.033；early PCI group18.71%vs.conservative group35.00%,P=0.007.MACE at1year follow-up:guideline group37.06%versus non-guideline group50.67%,P=0.004；primary PCI group35.48%vs.non-primary PCI group58.70%,P=0.046；primary PCI group35.48%vs.drug group75.00%,P=0.010；early PCI group37.41%vs.non-early PCI group49.21%,P=0.025；early PCI group37.41%vs.extension PCI group56.86%,P=0.016；early PCI group37.41%vs.conservative group56.25%,P=0.007.Recurrence of angina at1year follow-up:guideline group28.82%versus non-guideline group41.61%,P=0.006；primary PCI group22.58%vs.non-primary PCI group45.65%,P=0.039;primary PCI group22.58%vs.drug group62.5%,P=0.007；early PCI group30.22%vs.non-early PCI group40.87%,P=0.037；early PCI group30.22%vs.extension PCI group49.02%,P=0.016；early PCI group30.22%vs.conservative group45.00%,P=0.028.Re-admission at3months:early PCI group7.91%versus conservative group22.50%,P=0.002.Re-admission at1year-early PCI group11.51%versus conservative group30.00%,P=0.001.Conclusion:The PCI guideline(2009)could shorten the hospitalization period,reduced the incidence of MACE. recurrence of angina and re-admission of ACS patients.However,there were less than half of ACS patients accepted PCI within the given time according to the compliance requirements in the PCI guideline(2009).Therefore,it is hard for us to make more doctors and patients to understand the guideline and then put it into practice.