Department of Cardiovascular Medicine, The First Affiliated Hospital of Xi'an Medical University, Xi'an, Shaanxi, China.
Medicine (Baltimore). 2024 Oct 4;103(40):e40026. doi: 10.1097/MD.0000000000040026.
Standardized construction of China Chest Pain Center improves outcomes in patients with acute ST-segment elevation myocardial infarction (STEMI). A total 778 patients with a definite diagnosis of STEMI who underwent percutaneous coronary intervention (PCI) in our hospital from March 2017 to November 2022 were selected. Among them, 194 patients admitted from March 2017 to December 2019 were included as the pre-continuous improvement period (control group), and 584 patients admitted from January 2020 to November 2022 were included as the continuous improvement period (study group). Major quality control indicators were compared between the 2 groups. In continuous improvement period, the time of electrocardiograph (ECG) diagnosis, time of dual antiplatelet drug administration, troponin I return time, catheter activation time, and door to wire (D2W) were all significantly shorter than those in the pre-continuous improvement period (P < .05). The reperfusion rate of patients in the continuous improvement period was 98.12%, which was significantly higher than that in the pre-continuous improvement period (92.78%; P < .001). The mortality rate of STEMI patients in continuous improvement period was 3.42%, lower than 4.64% in the pre-continuous improvement period with no statistical difference (P = .439). Age, previous history of coronary artery disease, and high Killip class (Killip III-IV) were derived as independent risk factors for death by logistic regression analysis (OR>1, P < .05). Continuous improvement of the chest pain center can effectively shorten the treatment time of STEMI patients, improve the reperfusion rate, and improve myocardial blood supply by restoring TIMI blood flow as early as possible.
中国胸痛中心的标准化建设改善了急性 ST 段抬高型心肌梗死(STEMI)患者的预后。选取 2017 年 3 月至 2022 年 11 月在我院行经皮冠状动脉介入治疗(PCI)的确诊为 STEMI 的患者 778 例,其中 2017 年 3 月至 2019 年 12 月入院的 194 例患者纳入持续改进前阶段(对照组),2020 年 1 月至 2022 年 11 月入院的 584 例患者纳入持续改进阶段(研究组)。比较两组主要质量控制指标。持续改进阶段心电图(ECG)诊断时间、双联抗血小板药物应用时间、肌钙蛋白 I 恢复时间、导管激活时间和门球时间(D2W)均显著短于持续改进前阶段(P <.05)。持续改进阶段患者的再灌注率为 98.12%,明显高于持续改进前阶段的 92.78%(P <.001)。持续改进阶段 STEMI 患者死亡率为 3.42%,低于持续改进前阶段的 4.64%,差异无统计学意义(P =.439)。Logistic 回归分析显示,年龄、冠心病既往史和较高的 Killip 分级(Killip III-IV)是死亡的独立危险因素(OR>1,P <.05)。胸痛中心的持续改进能有效缩短 STEMI 患者的治疗时间,通过尽早恢复 TIMI 血流来提高再灌注率,改善心肌血供。