Influencing Factors And Prognosis Of S2FMC And D2B Time Delay In STEMI Patients In Northern Henan

BackgroundAcute ST elevation myocardial infarction(STEMI)is a common acute and critical illness in cardiovascular diseases,and the mortality rate is high.The construction of a chest pain center in my country opens up a fast track for STEMI patients and shortens the reperfusion time of primary percutaneous coronary intervention(PPCI)patients,which is of great significance to the treatment of STEMI patients.The symptom onset-to-first medical contact(S2FMC)time and the door to ball(D2B)time are the main indicators reflecting the time of PCI reperfusion therapy.The delay of the two will directly increase the mortality rate.But the specific factors affecting S2 FMC and D2 B time in northern Henan are not very clear.ObjectiveTo explore the influencing factors and prognosis of S2 FMC and D2 B time delay in SEIMI patients under the establishment of chest pain center in northern Henan,and to provide reference data for the management of STEMI patients’ treatment time in northern Henan.MethodsScreening of 515 patients diagnosed with STEMI and PPCI in the relevant chest pain center in the Henan Province Cardiovascular Disease Clinical Data and Sample Resource Library from December 2016 to December 2019.Collect clinical data including gender,age,smoking,drinking,sleep,and basics Medical history,education,place of residence,different time of onset,symptoms of onset,manner of admission,pulse of admission,admission systolic blood pressure,admission diastolic blood pressure,ECG diagnosis time,whether to bypass the emergency department,S2 FMC time,catheterization laboratory activation time,D2 B time,Killip grade,number of diseased branches,presence or absence of left main disease,hospital death.According to S2 FMC time,they were divided into:S2FMC time≤180min group(330 cases)and S2 FMC time>180min group(185 cases).According to D2 B time,they were divided into: D2 B time≤90min group(415 cases)and D2 B time>90min group(100 cases).Multivariate binary logistic regression was used to analyze the factors affecting S2 FMC time and D2 B time delay in STEMI patients.All-cause deaths and major adverse cardiovascular and cerebrovascular events within one year after the onset of the patient were followed up.According to whether they died within1 year,the groups were divided into death group(52 cases)and survival group(454 cases).Multivariate binary logistic regression was used to analyze the influencing factors of death in STEMI patients within 1 year.Results1.In the S2 FMC time grouping,the two groups of patients have statistically significant differences in age,gender,smoking,sleep,onset symptoms,and onset time(P<0.05).Incorporating the above 6 variables into the multivariate logistic regression analysis showed that women(OR: 2.110,95%CI 1.374～3.242,P=0.001),intermittent chest pain/chest tightness(OR: 2.001,95%CI 1.141～3.508,P=0.015)were significantly correlated with S2 FMC time delay in STEMI patients(P<0.05);while the time of S2 FMC is not easy to be delayed between 16:00-19:59 onset time(OR: 0.363,95%CI 0.193～0.680,P=0.002).2.When grouped according to D2 B time,the two groups of patients had statistically significant differences in drinking,hospital admission,ECG diagnosis time,emergency bypass,S2 FMC time,and cath lab activation time(P<0.05).Incorporating the above 6variables into the multivariate logistic regression analysis showed that the transfer to the outside hospital(OR: 0.211,95%CI 0.117～0.381,P<0.001)and the activation time of the cath lab(OR: 1.056,95%CI 1.032～1.082,P<0.001)was an independent factor influencing D2 B duration prolongation in STEMI patients(P<0.05).3.According to the survival and death within 1 year of follow-up,the multivariate binary logistic regression analysis found that: age(OR: 1.067,95% CI: 1.032～1.102,P<0.001),pulse(OR: 1.053,95% CI: 1.035～1.072,P<0.001),admission diastolic blood pressure(OR: 0.972,95% CI: 0.951 to 0.993,P=0.009),Killip classification(OR: 0.264,95% CI: 0.095 to 0.733,P=0.009),adverse cardiovascular and cerebrovascular events within 1 year(OR: 10.118,95% CI: 1.955～52.351,P=0.006),S2 FMC time(OR: 1.002,95% CI: 1.001～1.003,P=0.001)were independent influencing factors of death within 1year in STEMI patients(P<0.05).ConclusionsAmong the population in northern Henan,women and intermittent chest pain/chest tightness have a significant impact on the time delay of S2 FMC in STEMI patients.The onset time of S2 FMC from 16:00 to 19:59 is not easy to delay;the transfer to outside hospital and the activation time of the catheterization laboratory significantly affect the D2 B time.Meanwhile,time delay of S2 FMC was a significant factor affecting one-year all-cause mortality in STEMI patients in northern Henan.