The Impact Of Chest Pain Center Authentication On The Door-to-wiring Time In Acute Coronary Syndrome Patients Undergoing Primary Percutaneous Coronary Intervention

Objectives: The door-to-balloon time(D-to-B) is the most important indicator of the quality evaluation of chest pain centers’ operation. However, there is still a lack of reports investigating the influence of CPC authentication on the door-to-balloon time by large samples systematically in China. The paper aims to investigate the impact of the chest pain center authentication of First Affiliated Hospital to Soochow University on the door-to-wiring time.Methods: General information and clinical laboratory data were collected from the consecutive patients undergoing the primary percutaneous coronary intervention in the First Affiliated Hospital to Soochow University between Jan 1st, 2012 and July 31 st, 2015. Patients included in the research were divided into three groups according to the initiation time and the passage time of chest pain center authentication: pre CPC, during CPC and post CPC authentication groups. We compared the door-to-wiring time, the attainment rate, the length of hospital stay and the in-hospital mortality among three groups by the data collected and analyzed the impact of sex and gender factors on the door-to-wiring time.Result: By the one-way ANOVA, the door-to-wiring time of during CPC authentication group was 120±46min, which was significantly shortened versus pre CPC authentication group 160±49min(P<0.001); and the door-to-wiring time of post CPC authentication group was 123±52min, which was significantly shortened versus pre CPC authentication group 160±49min(P<0.001); however, the door-to-wiring time between during CPC authentication group and post CPC authentication group just remains unchanged(P=0.926). After four related factors were adjusted, the door-to-wiring time of during CPC authentication group was shortened by 38.89 minutes(net change from baseline) versus pre CPC authentication group(p=0.002), and the door-to-wiring time of post CPC authentication group was shortened by 76.85 minutes versus pre CPC authentication group(P<0.001).According to the guidelines at home and abroad of door-to-balloon below 90 minutes, the attainment rates of the three groups were analyzed as followed:6.89%, 26.95% and 26.58%(P<0.001).By the one-way ANOVA, the length of hospital stay of during CPC authentication group was 8±4 days, which was significantly shortened versus pre CPC authentication group 10±7 days(P=0.012);and post CPC authentication group was 8±3 days, which was significantly shortened versus pre CPC authentication group 10±7 days(P=0.018).After four related factors were adjusted, we found the length of hospital stay and the age were related significantly, the length of hospital stay of the elderly(age ≥63) increased 1.32 days versus the younger(age<63)(P=0.003).The in-hospital mortality of three groups were analyzed as followed: 6.50%, 8.51% and 3.80%(P>0.05). After four related factors were adjusted, we found the gender was significantly related with the door-to-wiring time and that the door-to-wiring time in male population was shortened by 13.92 minutes versus the female population. We also found that age had no relation with the door-to-wiring time(P=0.440).Conclusion: The chest pain center authentication of First Affiliated Hospital to Soochow University shortened the door-to-wiring time. Specifically, the door-to-wiring time of pre CPC authentication group was 160±49min, which fell to 120±46min in during CPC authentication group and fell to 123±52min in post CPC authentication group. After four related factors were adjusted, the door-to-wiring time of during CPC authentication group was shortened by 38.89 minutes versus pre CPC authentication group, and the door-to-wiring time of post CPC authentication group was shortened by 76.85 minutes versus pre CPC authentication group. The attainment rate was enhanced from 6.89% to 26.58% significantly. In addition, the chest pain center authentication reduced the length of hospital stay, lowered the in-hospital mortality, decreased the rate of adverse cardiovascular events and improved the treatment rate of primary percutaneous coronary intervention.