The In-hospital Diagnosis And Treatment Time In Patients Of The Acute ST Segment Elevation Myocardial Infarction

Objective: The purpose of this study is to investigate the in-hospital diagnosis and treatment time for patients with ST segment elevation myocardial infarction(STEMI),which provides the theoretical basis for further optimizing the treatment process of acute myocardial infarction and shortening the duration of treatment time in the future.Methods: We collected the diagnosis and treatment data of patients with acute myocardial infarction from January 2016 to December 2016 in major tertiary and some representative secondary hospitals in Hebei province.According to different treatment methods,patients were divided into thrombolysis group and PPCI group.In the thrombolysis group,the in-hospital diagnosis and treatment time was divided into three key steps: emergency admission to informing treatment method,informing treatment method to signning by patients,signning by patients to the start of thrombolysis.According to guidelines recommended Door-to-needle time(DTN),divide less than 30 minutes into non delayed groups and more than 30 minutes into delay groups.To compare the time distribution of each link between the delayed group and the non delayed group in the thrombolytic treatment group,and to compare the time distribution of patients in each link through different visit ways and different levels of hospitals.In the PPCI group,the in-hospital diagnosis and treatment time was divided into five key steps: emergency admission to informing treatment method,informing treatment method to signning by patients,signning by patients to notifying PCI staffs,notifying PCI staffs to starting PCI operation,starting PCI operation to Balloon dilatation.According to guidelines recommended Door-to-balloon time(DTB),divide less than 90 minutes into non delayed groups and more than 90 minutes into delay groups.To compare the time distribution of each link between the delayed group and the non delayed group in the thrombolytic treatment group,and to compare the time distribution of patients in each link through different visit ways.Results: A total of 1305 STEMI patients were collected,including 301 in thrombolysis group and 1004 in PPCI group.1.Compared with the recommended time of the guidelines: the median time of DTN in thrombolytic therapy group was 50 minutes,and the median time of DTB in PPCI treatment group was 120 minutes,which were higher than the recommended time of the guidelines.2.In the aspect of delay rate: in the thrombolytic therapy group,216 cases were delayed in hospital,71.8% of them were delayed in PPCI group,727 cases were delayed in hospital,72.4% of them were delayed.3.In the aspect of comparing the diagnosis and treatment links of non delayed group and delayed group,there was statistical difference between the three links of thrombolytic treatment group and DTN time(P < 0.05).There was statistical difference between the DTB time and the five diagnosis and treatment steps of PPCI group(P < 0.05).4.In the aspect of diagnosis and treatment links of different ways of admission: in the thrombolytic treatment group,there was a statistical difference in the link of emergency admission to informing treatment method and DTN time between Emergency medical system(EMS)and non EMS treatment group(P < 0.05).In the PPCI group,there were statistical differe-nces in the three diagnosis and treatment links: emergency admission to informing treatment method,notifying PCI staffs to starting PCI operation and DTB time between EMS and non EMS treatment group(P < 0.05).5.In the aspect of diagnosis and treatment links in different level hospitals: there was no statistical difference in each diagnosis and treatment links between the third level hospital and the second level hospital in the thrombolytic treatment group(P > 0.05).Conclusion: The delay in treatment of STEMI patients is serious.The median time of thrombolysis and PPCI was higher than that recommended by the guidelines.Hospital delay can occur in all aspects of diagnosis and treatment links.The time of diagnosis and treatment links,DTN and DTB can be improved by EMS.There was no significant difference in the time of diagnosis and treatment of thrombolysis in tertiary hospitals and secondary hospitals.