The Effect Of Tatal Ischemic Time On Prognosis Of STEMI Patients After PCI And The Establishment Of Regional Cooperative Treatment Systm Clinical Significance

Background:Since the 1990s,China has entered a mild aging society.At present,acute ST segment elevation myocardial infarction(STEMI)is one of the most serious diseases affecting the elderly with high mortality,and it has a trend of becoming younger.Studies have shown that,infarcted artery ischemia-reperfusion treatment time is closely related to the long-term and short-term prognosis of STEMI patients.With the extension of total ischemic time(TIT),the annual mortality of STEMI patients will gradually increase.Therefore,shortening the TIT,rapid and timely reperfusion therapy both can effectively protect the myocardium from long-term ischemic damage,thereby reducing the severe adverse prognosis of STEMI patients.In order to shorten the time of tit,after more than 10 years of research and exploration at home and abroad,a regional collaborative treatment system has been gradually formed.Regional collaborative treatment system can improve the early diagnosis rate of AMI patients,reduce the delay caused by diagnosis,transportation and other factors,significantly shorten the reperfusion time of occluded artery of patients first diagnosed in lower level hospitals without PCI ability,reduce the short-term mortality and improve the long-term prognosis.Objective:The purpose of this study is to explore the impact of total ischemic time on patients with acute ST segment elevation myocardial infarction and the clinical significance of regional collaborative treatment system after PCI.Methods:500 STEMI patients who met the inclusion criteria and were hospitalized in our Hospital from December 2017 to December 2019 were retrospectively studied.According to the different ways of coming to the hospital,they were divided into primary transfer group,120 transfer group and self transfer group.In addition,The primary transfer group was divided into cooperative group(group A)and non cooperative group(group B).The total ischemic time,the highest value of troponin and creatine kinase isoenzyme(CKMB),Killip grade at admission,cardiac ultrasound during hospitalization,length of stay and hospitalization expenses of different groups were recorded and analyzed.According to the above data,the mortality in hospital and one year later,and the incidence of major adverse cardiovascular events(MACE)one year later were analyzed.The predictors of 1-year mortality in STEMI patients after PCI were analysed by binary logistic regression analysis.Results:1.120 transfer group TIT and D-to-W time were significantly shorter than that in the self transfer group(196.67±150.66min vs 263.22±185.35min,P=0.002;65.43±9.62min vs 75.32±13.43min,P<0.01).In the primary transfer group,the TIT and D-to-W time of group A was significantly shorter than that of group B(257.85±136.80min vs 413.23±315.02min,P<0.01;76.49±15.74min vs88.67±20.28min,P<0.01);2.The postoperative in-hospital mortality[1%(1/100)vs 6.8%(17/250),P=0.02],The 1-year mortality[1.01%(1/99)vs 6.52%(15/230),P=0.04]and the 1-year MACE incidence[12.1%(12/99)vs 22.6%(52/230),P=0.02]of the 120 transfer group were lower than those in the self transfer group.In the primary transfer group,the postoperative in-hospital mortality[2.86%(2/70)vs 11.25%(9/80),P=0.03],1-year mortality[3.125%(2/64)vs 13.3%(8/60),P=0.03],1-year mace incidence[18.75%(12/64)vs 35%(21/60),P=0.03]in group A were lower than those in group B.3.On binary logistic regression analysis,the TIT>90min,Killip grade≥Ⅱ,multivessel disease,the peak value of CTn I and CKMB were the risk predictor of1-year mortality(OR 5.335,95%CI 1.257～22.648,P=0.023;OR 4.147,95%CI 1.083～15.878,P=0.038;OR 7.597,95%CI 1.321～43.684,P=0.023;OR 1.076,95%CI1.025～1.130,P=0.003;OR 0.990,95%CI 0.984～0.995,P<0.01).Conclusion:1.The shorter the time of TIT,the better the cardiac function,the lower the mortality and the incidence of MACE STEMI patients are.2.Patients with STEMI can call 120 in time after onset,and bypass non PCI hospital,emergency department and Coronary Care Unit under appropriate circumstances,which can shorten the tit to the maximum extent.3.The regional collaborative treatment system can shorten the TIT and effectively improve the regional STEMI treatment level.