胸痛中心患者病因调查及其建设对急性ST抬高型心肌梗死再灌注时间的影响

Investigation of Chest Pain Causes in CPC and its effect of CPC Construction on Reperfusion Time of Acute ST-elevation Myocardial Infarction

目的对就诊胸痛中心(CPC)的患者进行病因调查,并评估CPC建设对急性ST抬高型心肌梗死(STEMI)患者再灌注时间的影响。方法调查2017年7月—2018年6月因胸痛在中山大学附属东华医院胸痛中心诊治并在国家胸痛中心(CCPC)登记的2958例患者,分析胸痛患者病因,其中接受急诊经皮冠状动脉介入治疗(PCI)的STEMI患者定义为胸痛中心组。另外,从病案系统检索胸痛中心建立前2016年7月—17年6月接受急诊PCI的STEMI患者136例定义为非胸痛中心组。比较胸痛中心建设前后STEMI患者再灌注时间差异。结果2017年7月—2018年6月,因胸痛就诊胸痛中心的患者共2958例,其中STEMI210例(7.10%),非ST抬高型心肌梗死(NSTEMI)209例(7.07%),不稳定型心绞痛(UAP)264例(8.92%),非急性冠脉综合症(ACS)心源性胸痛963例(32.56%),主动脉夹层16例(0.154%),急性肺栓塞6例(0.20%),其他非心源性胸痛1185例(40.06%),放弃诊疗原因不明40例(1.35%),诊断中21例(0.71%)及其他44例(1.49%)。在210例STEMI患者中有158例(75.24%)接受了急诊PCI术。胸痛中心组较非胸痛中心组明显缩短进门-球囊(D2B)时间(74±56vs92±69min,P<0.05)。结论胸痛中心就诊患者中STEMI占7.10%,NSTEMI占7.07%以及UAP占8.92%;胸痛中心模式能显著缩短STEMI患者D2B时间.

Objective To investigate the causes of chest pains in the Chest Pain Center(CPC)and the effect of CPC construction on reperfusion time in patients with acute ST segment elevation myocardial infarction(STEMI).Methods Clinical data of all patients registered at the China Chest Pain Center(CCPC)from July 2017 to June 2018 in TungWah Hospital affiliated to Sun Yat-sen University were analyzed and classified in etiology.The patients with STEMI who received primary percutaneous coronary intervention(PCI)were defined as CPC group.Another 136 patients with STEMI who received primary PCI before CPC construction from July 2016 to June 2017 were defined as non-CPC group.Reperfusion time was compared between CPC and non-CPC group.Results From July 2017 to June 2018,there were 2,958 patients registered at CPC due to chest pain,including 210(7.10%)cases of STEMI,209(7.07%)cases of non-ST segment elevation myocardial infarction(NSTEMI),264(8.92%)cases of unstable angina pectoris(UAP),963(32.56%)cases of non-acute coronary syndrome(ACS)cardiogenic chest pain,16(0.154%)cases of aortic dissection,6(0.20%)cases of acute pulmonary embolism,1 185(40.06%)cases of non-cardiogenic chest pain.The cause of 40(1.35%)cases was still unknown,21(0.71%)cases of them were continuing to receive examinations.Besides,there were 44(1.49%)cases of other causes.75.24%(158/210)of cases with STEMI received primary PCI.Compared with non-CPC group,CPC shortened the time for door-to-balloon(D2B)(74±56 vs.92±69min,P=0.03).Conclusion In CCP,STEMI accounts for 7.10%,NSTEMI for 7.07%and UAP for 8.92%.CPC construction can significantly shorten the door to balloon time.