胸痛中心对急性ST段抬高型心肌梗死救治效率及在院期间预后的影响

Impacts of the chest pain center on the therapeutic efficiency and prognosis in hospital of patients with ST-segment elevated myocardial infarction

目的:探讨胸痛中心对急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)救治效率及在院期间预后的影响。方法:回顾性分析2014年3月~2017年5月明确诊断为并至于我院行急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的STEMI患者共131例,以胸痛中心通过认证时间为分界点,将患者分为认证前实施救治的STEMI患者为对照组(n=60)和通过认真后实施救治的STEMI患者为研究组(n=71)。分别比较两组患者PCI治疗过程中总缺血时间、入医院大门至球囊扩张(door-to-ballon,D2B)时间、首次医疗接触至球囊扩张(first medical contact-to-ballon,FMC2B)时间以及D2B时间、FMC2B时间达标率;并分析缺血总时间、D2B时间及FMC2B时间与在院治疗期间发生主要不良心血管事件(major adverse cardiovascular events,MACE)MACE的关系。结果:我们发现,胸痛中心成立后,STEMI患者的救治延迟现象得到显著改善;发生MACE的患者上述三种指标显著高于未发生MACE的患者,进一步应用logistic回归分析发现,总缺血时间、D2B时间>90min及FMC2B时间>120min是其独立危险因素,其优势比(OR)(95%CI)分别为1.07(0.93~1.23)、3.25(1.29~8.18)和4.30(1.78~10.41)。结论:胸痛中心的建立显著提高了STEMI患者救治效率,改善了救治延迟现象,改善STEMI患者PCI术后在院期间预后。

Objective To observe the impacts of the chest pain center(CPC)on the therapeutic efficiency and prognosis in hospital of patients with ST-segment elevated myocardial infarction(STEMI).Methods Total of 131 STEMI patients were retrospectively reviewed who underwent emergency PCI in our hospital between March 2014 to May 2017.All of them were divided into control group(n=60)before CPC certified and others as research group(n=71).The time of total ischemic,balloonto-balloon(D2B),first medical contact-to-balloon(FMC2B)and compliance rate of D2B time,FMC2B time were compared with two groups,meanwhile the relationship between time of total ischemia,D2B and FMC2B and major adverse cardiovascular events(MACE)during hospitalization after PCI was analyzed.Results Compared with before CPC certified,the delay in the treatment of STEMI patients was significantly improved by CPC;STEMI patients with MACE in hospital had longer time of total ischemia,D2B and FMC2B than those without,and we found that time of total ischemia,D2B and FMC2B were independent risk factors for MACE by using logistic regression analysis revealed that total ischemic time,their odds ratio(OR)(95%CI)was 1.07(0.93-1.23),3.25(1.29-8.18)and 4.30(1.78-10.41).Conclusion Establishment of CPC significantly improved the treatment efficiency of STEMI patients,and improved the delay of treatment and prognosis of STEMI patients in hospital after PCI.