胸痛中心认证对急性主动脉夹层患者医院结局的影响：中国的一项全国性研究。

Effectiveness of chest pain center accreditation on the hospital outcome of acute aortic dissection: a nationwide study in China.

机构信息

Department of Cardiology, Zhongshan Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai, 200032, China.

Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, China.

出版信息

Mil Med Res. 2024 Aug 26;11(1):62. doi: 10.1186/s40779-024-00565-0.

DOI:10.1186/s40779-024-00565-0

PMID:39183322

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11346265/

Abstract

BACKGROUND

The National Chest Pain Center Program (NCPCP) is a nationwide, quality enhancement program aimed at raising the standard of care for patients experiencing acute chest pain in China. The benefits of chest pain center (CPC) accreditation on acute coronary syndrome have been demonstrated. However, there is no evidence to indicate whether CPC accreditation improves outcomes for patients with acute aortic dissection (AAD).

METHODS

We conducted a retrospective observational study of patients with AAD from 1671 hospitals in China, using data from the NCPCP spanning the period from January 1, 2016 to December 31, 2022. The patients were divided into 2 groups: pre-accreditation and post-accreditation admissions. The outcomes examined included in-hospital mortality, misdiagnosis, and Stanford type A AAD surgery. Multivariate logistic regression was employed to explore the relationship between CPC accreditation and in-hospital outcomes. Furthermore, we stratified the hospitals based on their geographical location (Eastern/Central/Western regions) or administrative status (provincial/non-provincial capital areas) to assess the impact of CPC accreditation on AAD patients across various regions.

RESULTS

The analysis encompassed a total of 40,848 patients diagnosed with AAD. The post-accreditation group exhibited significantly lower rates of in-hospital mortality and misdiagnosis (12.1% vs. 16.3%, P < 0.001 and 2.9% vs. 5.4%, P < 0.001, respectively) as well as a notably higher rate of Stanford type A AAD surgery (61.1% vs. 42.1%, P < 0.001) compared with the pre-accreditation group. After adjusting for potential covariates, CPC accreditation was associated with substantially reduced risks of in-hospital mortality (adjusted OR 0.644, 95% CI 0.599-0.693) and misdiagnosis (adjusted OR 0.554, 95% CI 0.493-0.624), along with an increase in the proportion of patients undergoing Stanford type A AAD surgery (adjusted OR 1.973, 95% CI 1.797-2.165). Following CPC accreditation, there were significant reductions in in-hospital mortality across various regions, particularly in Western regions (from 21.5 to 14.1%). Moreover, CPC accreditation demonstrated a more pronounced impact on in-hospital mortality in non-provincial cities compared to provincial cities (adjusted OR 0.607 vs. 0.713).

CONCLUSION

CPC accreditation is correlated with improved management and in-hospital outcomes for patients with AAD.

摘要

背景

国家胸痛中心项目（NCPCP）是一个全国性的质量提升计划，旨在提高中国急性胸痛患者的护理标准。胸痛中心（CPC）认证对急性冠状动脉综合征的益处已经得到证实。然而，目前尚无证据表明 CPC 认证是否能改善急性主动脉夹层（AAD）患者的结局。

方法

我们对来自中国 1671 家医院的 AAD 患者进行了回顾性观察性研究，数据来自于 2016 年 1 月 1 日至 2022 年 12 月 31 日期间的 NCPCP。患者被分为认证前和认证后入院两组。评估的结局包括院内死亡率、误诊和 Stanford 型 AAD 手术。采用多变量逻辑回归探讨 CPC 认证与院内结局的关系。此外，我们根据地理位置（东部/中部/西部）或行政地位（省会/非省会城市）对医院进行分层，以评估 CPC 认证对不同地区 AAD 患者的影响。

结果

该分析共纳入 40848 例 AAD 患者。与认证前组相比，认证后组的院内死亡率和误诊率显著降低（12.1%比 16.3%，P<0.001 和 2.9%比 5.4%，P<0.001），Stanford 型 AAD 手术率显著升高（61.1%比 42.1%，P<0.001）。在校正潜在混杂因素后，CPC 认证与院内死亡率（校正 OR 0.644，95%CI 0.599-0.693）和误诊率（校正 OR 0.554，95%CI 0.493-0.624）显著降低相关，同时 Stanford 型 AAD 手术比例增加（校正 OR 1.973，95%CI 1.797-2.165）。CPC 认证后，各地区的院内死亡率均显著降低，特别是西部地区（从 21.5%降至 14.1%）。此外，与省会城市相比，CPC 认证对非省会城市的院内死亡率的影响更为显著（校正 OR 0.607 比 0.713）。