| [Objective]To explore effect of difference time periods of DIDO(door-in to door out)of STIMI patient referral hospital on various rescue and treatment time and prognosis.[Methods]444 patients with STEMI(ST-segment elevation myocardial infarction,acute ST segment elevation myocardial infarction)who were transferred to 920th Hospital of Joint Service Support Force from referral hospital from July 1st 2017 to March 10,2019 and who underwent emergency treatment PCI surgery and who were in accordance with inclusion criteria were retrospectively analyzed.These patients were divided into ≤30 min group(262 cases)and>30min group(182 cases)according to DIDO time,major rescue and treatment time node in chest pain medical system,myocardial perfusion status during patient hospitalization,myocardial injury biomarkers and cardiac-ultrasound related data were recorded and analyzed;follow-up record was conducted by patient re-hospitalization,outpatient reexamination and telephone call;mortality and incidence of major adverse cardiac and cerebro-vascular events(MACCE)during hospitalization and follow-up period were statistically analyzed.Binary logistic regression model was adopted to analyze factors related with mortality in 1 year after surgery and MACCE incidence in 1 year after discharge of STEMI patients,and Cox proportional risk regression model was used to analyze accumulated mortality in 2.5 years after surgery and predictive factors of MACCE free survival rate in 2.5 years after discharge.[Results]1.FMC2B(First medical contact-to-Balloon)time in DIDO time≤30 min group and DIDO time>30 min group[154(121,253)vs 201.5(141,302 min,P<0.05)],the time has been significantly shortened,the difference has statistical significance;inter-group difference on corresponding D2B(Door-to-Balloon,admission diagnosis to first balloon dilation)time between DIDO time ≤30 min group and DIDO time 30 min group has no statistical significance.2.Compared with DIDO time>30 min group,postoperative 12 hour BNP,CKM>B(creatine kinase-MB)peak value and CTnI(cardiac troponin I)peak value in DIDO time ≤30min group were significantly low,and postoperative TIMI(Thrombolysis in myocardial infarction)level 3 blood flow ratio in DIDO time ≤30min group was significantly high,all the differences have statistical significance(P<0.05);compared with DIDO time ≤30min group,CTFC(Corrected TIMI frame count)value in DIDO time>30min group was significantly low[25(25,26)vs 27(26,29),P<0.05],the difference has statistical significance;compared with DIDO time ≤30min group,CTFC ≤28 compliance rate in DIDO time>30min group was significantly high,the difference has statistical significance(69.85%vs 59.34,P<0.05);LVEF(Left ventricular ejection fraction)mean value in 1 week after surgery of patients in DIDO time ≤30min group was higher than DIDO time>30min group,mean value of postoperative 1 week LVEDD(Left ventricular end-diastolicdimension)in DIDO time≤30min group was lower than DIDO time>30min group,both inter-group differences have statistical significance(P<0.05);however,LVEF mean value in 1 year after surgery of patient in DIDO time ≤30min group was obviously higher than DIDO time>30min group,and the difference has no statistical significance,and LVEF mean value decrease trend in 1 year after surgery of patient in DIDO time ≤30min group was more obvious than DIDO time>30min group,and the inter-group difference has no statistical significance(P>0.05);compared with DIDO>30min group,ST segment of DIDO time ≤30min group has no resolution(STR<30%),the percentage in total number of this group is even lower,however,the difference on STR(ST-segment resolution)has no statistical significance(P>0.05);3.Both the postoperative in-hospital mortality(1.5%vs 2.1%,P=0.057)and mortality in 30 days after surgery(4.2%vs 5.5%,P=0.052)of DIDO time ≤30min group and DIDO time>30 min group were decreased,however,both the inter-group differences have no statistical difference;1 year mortality(2.3%vs 8.2%,P=0.004)and incidence of MACCE(Major adverse cardiac and cerebro-vascular eventsevents)in 1 year after discharge(7.6%vs 17.0%,P=0.002)of patients in DIDO time ≤30min group were significantly lower than DIDO time>30min group,inter-group difference has statistical significance;accumulative mortality in 2.5 years after surgery of DIDO time ≤30min group was significantly lower than DIDO time>30min group,the intra-group difference has statistical significance(3.00%to 12.0%,P=0.016);MACCE free survival rate in 2.5 years after surgery of DIDO time ≤30min group was significantly higher than DIDO time>30min group,the intra-group difference has statistical significance(98.9%to 86.0%,P=0.002).And logistic regression analysis showed that DIDO time>30 min was an independent risk factor for mortality in 1 year after surgery and MACCE incidence in 1 year after discharge(OR=4.084,95%CI 1.487-11.217,P=0.006);Cox single factor analysis result showed that DIDO time>30 min was independent risk factor for accumulative mortality in 2.5 years after surgery(HR=0.425,95%CI 0.250-0.723,P=0.002);Cox risk model multiple-factor analysis showed that DIDO time>30 min was still an independent risk factor for 2.5 year-accumulative mortality after independent predictors demonstrated by single factor analysis results and FMC2B time needed to correct for confounding were included as covariates and correction for baseline data and other confounding factors(HR=2.507,95%CI 1.282-3,911,P=0.024);Cox single factor analysis results showed that DIDO time>30min was an independent risk factor for MACCE incidence in 2.5 years after discharge(HR=1.433,95%CI0.893-2.298,P=0.013);4.It was found that DIDO time>30min was an independent risk factor for killip≥grade Ⅱ rate after adoption of binary logistic regression in analysis of affecting factors of patient killip≥grade Ⅱ rate and correction for baseline data and other confounding factors(OR=3.454.95%CI 2.25-5.40,P=0.001);multiple regression analysis result showed that DIDO time>30min was an independent predicative factor for STEMI patient CTFC>28(OR=0.106,95%CI 0.05-0.21,P=0.001);[Conclusions]1.When DIDO time is shortened,the corresponding FMC2B time and S2B time are also shortened correspondingly.DIDO belongs to key components of FMC2B in the process of transferring to PCI hospitals from a referral hospital at first visit(hospital that does not have direct PCI capacity)either by the patient himself or by ambulance.DIDO time is not an isolated time period,it directly affects FMC2B time and even S2B time.2.DIDO time<30min can effectively decrease the incidence of poor myocardial perfusion of STEMI patients and improve cardiac function of the patients.Delay of ischemia time of STEMI patients can lead to enlargement of myocardial infarction area,microcirculation disorder and cardiac dysfunction.3.DIDO time ≤30min can decrease MACCE incidence after discharge and patient mortality after discharge.4.DIDO time>30min group is an independent risk factor for killip ≥Grade Ⅱrate and CTFC>28. |
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