Effect Of Onset-to-Door Time And Door-to-Balloon Time On Prognosis In Patients Undergoing Primary Percutaneous Coronary Interventions For St-Segment Elevation Myocardial Infarction

Objective:This study analyzed the clinical data of ST-Segment Elevation Myocardial Infarction(STEMI)patients undergoing primary percutaneous coronary intervention(p PCI)in three third-grade class-A hospitals in Cheng Du.To discuss the effects of S2D(onset to door)time and D2B(door to balloon)time on in-hospital incidence of acute heart failure,and identify the potential risk factors for in-hospital mortality in STEMI patients.Methods:The clinical data of 403 patients with STEMI undergoing p PCI after constructing the chest pain center in three third-grade class-A hospitals in Cheng Du were enrolled.According to whether died in hospital after p PCI,patients were divided into survival group(390 patients)and death group(13 patients).The clinical baseline characteristics,the operation status and the incidence of heart failure and mortality during hospital were compared between the two groups.Logistic regression analysis was used to indentify the potential risk factors for in-hospital mortality.The ROC work characteristic curve was used to determine the weight of these risk factors.And subgroup analysis was performed to investigate the effects of S2 D time and D2 B time on acute heart failure during hospital by devided patients into two groups according to S2D(>240min or ≤240min)or D2B(> 90 min or ≤90min).Statistical analysis was performed using SPSS 21.0 software.P < 0.05 is considered statistically significant.Results:(1)A total of 403 patients were enrolled,325 males and 78 females,and males were significantly higher than females(80.6% vs 19.4%).However,the proprtion of female patients in the death grops was higher than that in the survials,and the difference was statistically significant between the two groups(P<0.05).(2)Subgroup analysis performed with S2 D time: the proportion of acute heart failure occurred in hospital in group A(S2D≤240min)and the proportion of death in hospital were lower than those in group B(S2D>240min),and the LVEF value after p PCI of group A was higher than group B,which the difference was statistically significant(P<0.05).(3)Subgroup analysis performed with D2 B time:the in-hospital mortality rate in group C(D2B≤90min)was significantly lower than that in group D(D2B>90min)(P<0.05),but the incidence of acute heart failure in hospital and the LVEF value after p PCI was not significantly different between the two groups(P>0.05).(4)Clinical data of death and survival groups:there was no significant difference in history of coronary heart disease,history of COPD,history of hypertension,history of diabetes,history of hyperlipidemia,history of cerebral infarction,admission heart rate,TC,LDLC,TG between the two groups(P>0.05).Patients in the two groups in gender,age,the history of smoking,Killip classification ≥III,systolic blood pressure,number of target vessels,S2 D time and D2 B time,Cr,CS,HGB were significant differences(P<0.05).(5)Logistic regression analysis showed: gender(OR=5.862,95% CI 1.380~24.902,P=0.017),Killip classification ≥III(OR=5.120,95% CI 1.059~24.747),systolic blood pressure(OR=0.948,95% CI The time of 0.916~0.980)and S2 D time(OR=1.001,95% CI 1.000~1.002)were the potential risk factors for in-hospital mortality of STEMI patients after p PCI(P<0.05).(6)ROC curve analysis of death factors during hospitalization: S2 D time(AUC=0.775,P=0.001),Killip classification≥III(AUC=0.769,P=0.001),and gender(AUC=0.636,P=0.095)had a good predictive value for in-hospital death of STEMI patients undergoing p PCI.Conculusion:S2D time may be a potential risk factor for acute heart failure in the hospital.Gender,cardiac function Killip classification≥III,S2 D time were important factors influencing hospital mortality in STEMI patients,and have certain predictive value for patients with in-hospital death.