Influence Of Chest Pain Center Construction Under The "Hospital-dependent Emergency Mode" In Acute ST-segment Elevation Myocardial Infarction Patients

Objective To analyze the influence of chest pain center(CPC)construction under the “hospital-dependent emergency mode” in the reperfusion therapy for acute ST-segment elevation myocardial infarction(STEMI)patients,evaluate whether it can improve the therapeutic effect,and reduce the reperfusion time,total ischemic time(Tit),hospitalization time,economic costs and incidence rate of major adverse cardiovascular events(MACE),and record its treatment conditions and clinical prognosis,and study its significance and social benefits.Methods STEMI patients with acute chest pain confirmed from March 2015 to December 2017 in Fujian Provincial Hospital were reviewed.According to inclusion and exclusion criteria,391 patients were finally screened out.Upon CPC construction(2016.8-2017.12),209 patients were selected as study group;prior to CPC construction(2015.3-2016.7),182 patients were selected as control group.The clinical indicators as well as left ventricular ejection fraction(LVEF)and left ventricular end-diastolic diameter(LVEDD),and incidence rate of ventricular aneurysm and MACE(heart failure,case fatality,re-admission)were compared.Results Patient's general data between groups showed no statistically significant difference(P>0.05);the results between groups were comparable;the values of troponin I(cTnI)and N-terminal pronatriuretic peptide(NT-ProBNP)before and after surgery as well as creatine kinase-MB(CK-MB)before surgery,prothrombin time(PT),activated partial thromboplastin time(APTT),International Normalized Ratio(INR),D-dimer(D-D),procalcitonin(PCT),hemoglobin(Hb),alanine aminotransferase(ALT),aspartate aminotransferase(AST),creatinine(Cr),cholesterol(TC),triglycerides(TG),high-density lipoprotein(HDL-C),low-density lipoprotein(LDL-C),apolipoprotein A(Apo A)and apolipoprotein B(Apo B)between groups showed no statistically significant difference(P>0.05);the values of white blood count(WBC)and CK-MB after surgery in the study group were lower than those in the control group,with statistically significant difference(P<0.05);the number of culprit vessels and diseased vessels,preoperative cases at TIMI(Thrombin Inhibition in Myocardial Infarction)0/1 and postoperative cases at TIMI 3 between groups showed no statistically significant difference(P>0.05);the time of catheter to balloon dilatation between groups showed no statistically significant difference(P>0.05);the time of symptom onset to first medical contact(S-to-FMC),first medical contact to electrocardiography(FMC-to-EKG),troponin acquisition,cardiology department consultation notification to consultation,first medical contact to administration for ACS(Acute coronary syndrome),diagnosis confirmation to signing,first medical contact to balloon(FMC-to-B),Door-to-Balloon(D-to-B)as well as total Ischemic time(Tit)in the study group was shorter than that in the control group,with statistically significant difference(P<0.05);the standard time of FMC-to-B and D-to-B between groups showed statistically significant difference(P<0.05);the transmission rate of electrocardiograph(ECG)data in the control group(24.18%)was lower than that in the study group(91.87%),with statistically significant difference(P<0.05);the control group had 3 cases of calling 120,79 cases of seeing doctors on their own,94 transferred cases and 6 cases of admitting in the hospital;the study group had 5 cases of calling 120,72 cases of seeing doctors on their own,128 transferred cases and 4 cases of admitting in the hospital;the number of patients at stage I,stage II,stage III and stage IV of Killip as well as the values of LVEF and LVEDD between groups showed no statistically significant difference(P>0.05);the incidence rate of MACE in the study group was lower than that in the control group,with statistically significant difference(P<0.05);the number of patients with Gensini scores <50,50-80 and >80 between groups showed no statistically significant difference(P>0.05);compared with control group,the hospitalization costs,time of staying in ICU(intensive care unit)and overall hospitalization time in the study group were reduced(P<0.05);after 1y of surgery,the values of LVEF and LVEDD,incidence rate of ventricular aneurysm and case fatality,re-admission rate between groups showed no statistically significant difference(P>0.05);the incidence rate of heart failure in the study group was lower than that in the control group,with statistically significant difference(P<0.05);MACE(Yes=1,No=0)was taken as dependent variable.Logistic regression analysis indicated that the time of S-to-FMC and FMC-to-EKG,troponin acquisition,cardiology department notification-consultation,first medical contact to administration for ACS,diagnosis confirmation to signing,FMC-to-B,D-to-B,Tit and transmission rate of ECG data were the independent influence factors of MACE.Conclusion CPC construction under the “hospital-dependent emergency mode” can make full advantage of 120 first-aid resources and local collaborative emergency network platform,give full play to multiple disciplinary team,optimize the emergency procedures for myocardial infarction,shorten Tit and hospitalization time,reduce the incidence rate of MACE and treatment costs,save the medical resources and achieve better social benefits.