| ObjectiveTo analyze the impact of continuous improvement of the construction of Chest Pain Center(CPC)in our hospital on the critical time point,process and prognosis of patients with ST-segment elevated myocardial infarction(STEMI).MethodFrom January to December 2018,155 patients with STEMI and primary percutaneous coronary intervention(PPCI)were retrospectively analyzed during the construction,trial operation and continuous improvement of a standardized chest pain center in our hospital according to the Chinese Chest Pain Center certification standards.From January 2018 to July 2018,66 patients were admitted to the chest pain center at the early stage of trial run as the control group;from August 2018 to December 2018,89 patients were admitted to the chest pain center at the late stage of trial run as the observation group.The differences in general clinical data,Symptom onset to first medical contact(S-to-FMC),catheterization laboratory activation time,door to balloon time(D-to-B)and other key time points,treatment procedure,incidence of in-hospital complications,length of hospital stay,hospitalization costs and prognosis between the two groups were compared.Result1.The early stage of trial compared with the late stage of trial,the time from FMC to ECG [(7.78 ± 1.47)min vs.(5.02 ± 0.28)min,P = 0.035],time from ECG diagnosis [(6.65 ± 0.60)min vs.(3.92 ± 0.23)min,P < 0.001],time from FMC to Dual antiplatelet therapy [(47.41 ± 7.63)min vs.(29.33 ± 2.62)min,P = 0.014],time from FMC to agreed PCI [(33.86±1.09)min vs.(30.53±0.75)min,P=0.010],activation time in catheterization laboratory [(21.59 ± 0.82)min vs.(18.13 ± 0.67)min,P = 0.001],troponin detection time [(24.38 ± 0.45)min vs.(17.82 ± 0.25)min,P < 0.001],D-to-B time [(63.52 ± 6.02)min vs.(50.22 ± 6.27)min,P = 0.040] and the time from FMC to PCI completed [(103.20 ± 1.69)min vs.(89.50 ± 1.26)min,P<0.001] were all shorter,and the differences were statistically significant.The S-to-FMC time [(418.70 ± 95.05)min vs.(376.70 ± 50.87)min,P > 0.05] shows no statistical significance.2.The early stage of trial compared with the late stage of trial,the proportion of tele-ECG transmission [48.5%(32/66)vs.87.6%(78/89),P < 0.001] and the proportion of detours to the emergency department and coronary care unit(CCU)to the catheterization laboratory [57.6%(38/66)vs.74.1%(66/89),P = 0.030] increased,and the differences were statistically significant.The proportion of patients with thrombolysis[3.0%(2/66)vs.5.6%(5/89),P > 0.05]shows no statistically significant.3.The early stage of trial compared with the late stage of trial,the proportion of ?-blocker use [68.2%(45/66)vs.75.3%(67/89),P > 0.05],ACEI/ARB use [65.2%(43/66)vs.69.7%(62/89),P > 0.05] and intensive statin use [75.8%(50/66)vs.80.9%(72/89),P > 0.05] within 24 hours shows no statistically significant.4.The early stage of trial compared with the late stage of trial,the hospital stay [(8.10 ± 0.53)vs.(7.53 ± 0.28)days,P>0.05],incidence rate of major adverse cardiovascular events(MACE)[7.6%(5/66)vs.6.32%(6/89),P>0.05] and the mortality rate [4.5%(3/66)vs.1.1%(1/89),P>0.05] shows no statistically significant.The hospitalization expenses [(45130 ± 1,813)vs.(40646 ± 899.7)yuan,P = 0.018] decreased,and the difference were statistically significant.Conclusion1.Continuous improvement in the construction of chest pain centers can reduce healthcare system delays in patients with STEMI,and reduces hospital costs in patients with STEMI. |
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