Effect Of Regional Synergistic System Based On Wechat Plantform On Stemi Treatment In County-level Hospitals

ObjectiveST-segment elevation myocardial infarction(STEMI)refers to a type of acute myocardial infarction with typical ischemic chest pain.Such patients' concentration of myocardial injury markers increases and dynamically evolves,and their ECG has a typical ST-segment elevation.Reperfusion therapy as soon as possible can reduce the infarct area and save the dying myocardial cell,thus improving the prognosis of these patients.Current research found that a regional synergistic treatment system characterized by chest pain center can shortening the time from the onset to coronary revascularization and improve the efficiency of STEMI treatment significantly.However,there exist few studies about how to promote effectively the system among county-level hospitals.Relying on the rapid development of Internet technology and the popularity of smart phones,our study was designed to evaluate the effect of establishing a regional synergistic system between county-level hospitals based on WeChat platform in the treatment of acute ST-segment elevation myocardial infarction,hoping to provide new perspective for STEMI treatment of basic-level hospitals.MethodsWeChat group transmission by smart phones was used as an interactive platform for real-time disease status(illness,ECG,inspection results,coronary angiography,etc.).The affiliated Kunshan Hospital of Jiangsu University and other 9 secondary hospitals in Kunshan area participated together in this study.We constituted the regional synergistic STEMI treatment system by WeChat groups.A large group of chest pain center was jointly participated by the emergency department,cardiology department and other medical staff of each hospital,and 9 groups of point-to-point between each hospital and the department of cardiology of our hospital were created.This study evaluated 161 patients who were first diagnosed in the 9 secondary hospitals and underwent percutaneous coronary intervention(PCI)in our hospital between January 2015 and December 2017.The included subjects were then divided according to the implementation of the system into two groups: 78 patients without the system and 83 patients with the system.The diagnosis of STEMI is according to the STEMI diagnostic criteria in the 2015 edition of the Guidelines for the Diagnosis and Treatment of Acute ST-Segment Elevation Myocardial Infarction.All the patients agreed with CAG treatment within 12 hours after the onset of disease.The exclusion criteria included non-ST-segment elevation myocardial infarction,unstable angina,aortic dissecting aneurysm,aortic dissecting aneurysm,embolism of pulmonary artery,severe hepatic and renal dysfunction,inflammatory or infectious disease,active hemorrhage,severe anemia,advanced tumor,and so on.Several data were collected.Clinical baselines: age,gender,smoking history,history of hypertension,history of diabetes,history of hyperlipidemia,systolic blood pressure,diastolic blood pressure,heart rate,Killip cardiac function grading before PCI.Laboratory markers: total cholesterol,triglyceride,high density lipoprotein cholesterol,low density lipoprotein cholesterol,N-terminal B-type natriuretic peptide,and so on.Surgical data: number of diseased vessels,distribution of infarction related artery(IRA),number of stents.Time nodes of treatment: first medical contact time,time to enter our hospital,balloon expansion time,first medical contact to balloon(FMC-to-B)time,door to balloon(D-to-B)time,referral time.Relevant information on social and economic benefits: the patient's hospital bed day,hospitalization expenses,and discharge satisfaction assessment materials.Patient discharged from hospital for 3 months prognostic index: left ventricular ejection fraction,left ventricular end-diastolic dimension,and occurance of major adverse cardiovascular events.Suitable statistical analysis was performed to assess the data above.Results1.There existed no significant differences in age,gender,coronary heart disease risk factors,Killip cardiac function grading before PCI,blood pressure,heart rate and preoperative biochemical markers between the two groups.2.The number of diseased vessels,IRA distribution,and number of implanted stents between the two groups showed no difference.3.The first medical contact to balloon(FMC-to-B)time,door to balloon(D-to-B)time,and the referral time of STEMI patients were significantly reduced after implementation of the regional synergistic system for STEMI treatment(P<0.05).Compliance rate of FMC-to B and D-to-B improved both.4.Patients enjoyed shorter average hospitalization time and expenses within the system,and expressed higher satisfaction after the implement of the system.5.Left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDd)of patients in the experimental group leaving from hospital for 3 mouths involved through this system.6.All patients discharged from the hospital were followed up.Both groups had MACEs such as ventricular tachycardia,heart failure and death.However,the incidence of MACEs was significantly lower than that before operation of the system.ConclusionOur study highlighted the value of implementing of the regional synergistic system for STEMI treatment based on WeChat platform in county-level hospital.1.These results suggest the system could improve early identification and diagnosis of STEMI patients,optimize the transport process,reduce FMC-to-B and D-to-B time.2.And also the system could make better protection of heart function,reduce the complications,and improve the prognosis,while ease the economic burden of patients.Patient satisfaction was effectively improved.3.Together,it can continuously promote the two-way referral,update the STEMI treatment concept of doctors in basic-level hospitals and thus significantly enhance the ability of STEMI treatment in the region.