| Objective The purpose of this study was to evaluate the effect of CPC construction on the clinical prognosis of STEMI patients with PPCI by observing and comparing the time index,curative effect and prognosis of STEMI patients treated with PPCI under the conventional mode and the(CPC)mode of chest pain center,in order to evaluate the influence of CPC construction on the clinical prognosis of patients with STEMI.Methods: 1 According to the request of China chest pain Center,the standard version of(CPC)of chest pain Center was formally established in September 2017 and approved by the first Central Hospital of Baoding City.From March 2017 to August 2017,143 STEMI patients with PPCI who were treated before the establishment of the chest pain Center in Baoding City were selected as the pre-center group.STEMI of PPCI was treated after the establishment of the chest pain Center from October 2017 to March 2018.272 patients were created as the center of the post-group.The patients in the pre-center group were rescued and treated according to the routine procedure,and the patients in the post-center group entered the "green channel" according to the requirements and norms of the chest pain center.2 Outcome measures: the general data of two groups were recorded,including sex,age,history of smoking,history of hypertension,history of diabetes and serum creatinine.The BNP concentration of LVEF,LVEDD,was measured by echocardiography on admission,and the time of treatment was recorded(the time of the first ECG after admission,the time of initiation to activation of the catheterization room,the time of entry to balloon dilation,D2B).Incidence of heart failure during hospitalization,mortality rate,length of stay in hospital,cost of hospitalization,mortality rate,re-admission rate,incidence of heart failure after 6 months of follow-up,LVEF,LVEDD,BNP concentration recorded at the time of re-visit3 Definition of related indicators3.1 Definition of heart failure: according to the Killip classification of heart failure,grade 2 and above are defined as heart failure.3.2 Door to baloon(D2B)defines: the time it takes for the patient to enter the hospital gate until the balloon is fully dilated at the criminals' vascular stenosis.4 Statistical processing: SPSS19.0 software was used for statistical analysis.The measurement data were expressed as mean ±standard deviation,t-test was used for comparison between groups,and the acceptance rate of counting data(%)was expressed by x~2 test,which was statistically significant with p < 0.05 as the difference.Results: 1 There was no significant difference in sex,age,smoking history,hypertension history,diabetes history and serum creatinine level between the two groups(P > 0.05).There was no significant difference in LVEF,LVEDD,BNP concentration between the two groups at admission(P > 0 05).2 The time to complete the first ECG was 6.20 ±3.10 min after the center was created,which was shorter than 26.10 ±10.20 min.before the center was created.The start-up to activation time of catheterization was 22.05 ±16.12 min,after the center was created,which was significantly shorter than 62.03 ±18.12 min.before the center was created.The time of D2 B was 88.02 ±30.01min,in the group after the center was created,which was significantly shorter than that in the group before the establishment of the center(168.08 ±79.06 min.).The above differences were statistically significant(p < 0.05).3 The mortality rate during hospitalization and heart failure in the post-center group was 2.50%(7/272)and 19.80%(54/272)respectively,which was lower than that in the pre-center group(6.30%(9/143).The incidence of heart failure was 26.50%(38/143),the difference was statistically significant(p < 0.05).4 After the establishment of the center,the number of days in hospital was 9.03 ±3.12 days and the cost of hospitalization was 36723.8 ±8432.50 yuan,which was lower than that of the pre-center group 13.03 ±3.98 days and 47934.60 ±9397.50 yuan.There was significant difference between the two groups(p < 0.05).5 Left ventricular ejection fraction(LVEF)was 49.00 ±17.30% in the group after the establishment of the center 6 months after discharge,and 41.00 ±18.20% in the group before the establishment of the center.The left ventricular end-diastolic diameter was 54.00 ±15.00 mm,and the re-admission rate of 141.00 ±102.20 pg/ml,was 6.25%(18/143mm).The incidence of heart failure was 10.30%(28/272)and the mortality rate was 2.20%(6 / 272).The re-admission rate of left ventricular end-diastolic diameter was 61.00 ±17.00 mm,BNP 254.00 ±119.10 pg/ml,in the pre-central group,and the re-admission rate was 12.60%(18/143).The incidence of heart failure was 25.90%(37/143)and the mortality rate was 5.60%(8/143).The above differences were statistically significant(p < 0.05).Conclusion: 1 The construction of chest pain center can effectively shorten the hospital treatment time of STEMI patients,and improve the efficiency and level of treatment.2 The central construction of chest pain has reduced the hospital stay and the cost of hospitalization for patients with STEMI.The rate of hospital and post-discharge mortality and heart failure was reduced,and the rate of readmission in the hospital was also reduced,and the clinical outcome of the patients was improved. |
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