标准版胸痛中心对急性心肌梗死住院患者治疗状况的单中心报告

Report on the therapeutic status of acute myocardial infarction patients in a single center of standard chest pain center

目的通过分析河北医科大学第二医院胸痛中心建设前后急性心肌梗死(acute myocardial infarction,AMI)患者的救治效果和院内主要不良心脏事件(major adverse cardiac events,MACE)的发生情况,为进一步优化AMI治疗和胸痛中心管理提供参考。方法选取河北医科大学第二医院胸痛中心2018年1月至12月收治的AMI患者458例纳入研究组,将2015年1月至12月该院进行胸痛中心建设前收治的AMI患者334例纳入对照组。比较两组患者基本情况(年龄、性别、既往病史、受教育程度、长期居住地、入院时Killip分级等)、心肌梗死救治情况(发病至首次医疗接触时间、首诊医院、再灌注治疗方式、介入治疗前后梗死相关动脉心肌梗死溶栓血流分级等)、住院期间MACE发生情况、住院天数和发病1个月内患者的病死率。结果两组患者性别、年龄、体质指数、既往病史、受教育程度、心肌梗死分型、病例来源和入院时Killip分级比较差异均无统计学意义(均P>0.05)。研究组患者首诊于基层胸痛中心的比率显著高于对照组(P<0.001)。研究组ST段抬高型心肌梗死患者溶栓后2~24 h冠状动脉造影(coronary angiography,CAG)+经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)、PCI前心肌梗死溶栓血流分级3级、冠状动脉内溶栓治疗比率均显著高于对照组(均P<0.001),溶栓后择期CAG+PCI比率显著低于对照组(P<0.001)。研究组患者住院天数显著短于对照组(P<0.001),住院期间急性心力衰竭发生率显著低于对照组(P=0.040)。两组患者非计划靶血管再次血运重建、消化道出血、前臂血肿、输血、恶性心律失常发生率和发病1个月内死亡率比较差异均无统计学意义(均P>0.05)。结论通过胸痛中心建设,加强了河北医科大学第二医院AMI诊疗辐射能力,AMI患者死亡率有下降趋势,AMI救治效果初步显现。但是在患者教育、再灌注治疗等方面仍有待进一步优化完善。

Objective To analyze the treatment effects of patients with acute myocardial infarction(AMI)and the incidence of major adverse cardiac events(MACE)before and after the establishment of the chest pain center(CPC)in the Second Hospital of Hebei Medical University,to provide reference for further optimizing AMI treatment and CPC management.Method A total of 458 AMI patients admitted to the CPC of the Second Hospital of Hebei Medical University from January to December 2018 were enrolled in study group.Three hundred and thirty-four AMI patients admitted to that hospital before the construction of CPC from January to December 2015 were included in control group.The patient's basic conditions(age,gender,previous history,education,long-term residence,and Killip grading,etc.),treatment of myocardial infarction[time of first medical contact,first diagnosis hospital,reperfusion treatment,thrombolysis in myocardial infarction(TIMI)blood flow grading of infarction related artery before and after interventional therapy,etc.],MACE during the hospitalization,hospital day and mortality of patients followed up for 1 month were compared between the two groups.Result There were no statistically significant differences in gender,age,body mass index,previous history,education,type of myocardial infarction,source of cases and Killip classification between the two groups(all P>0.05).The ratio of patients in study group to primary CPC was significantly higher than that in control group(P<0.001).In study group,patients with ST-segment elevation myocardial infarction of coronary angiography(CAG)+percutaneous coronary intervention(PCI),TIMI blood flow level 3 before PCI,and the rates of intra-coronary thrombolysis were significantly higher than those in control group(all P<0.001),the rate of CAG+PCI after thrombolysis was significantly lower than that of control group(P<0.001).The hospital stay in study group was significantly shorter than that in control group(P<0.001),the incidence of acute heart failure during hospitalization was significantly lower than that in control group(P=0.040).There were no statistically significant differences in the incidence of unplanned target vessel revascularization,gastrointestinal bleeding,forearm hematoma,blood transfusion,malignant arrhythmia and mortality within 1 month of onset between the two groups(all P>0.05).Conclusion Through the construction of CPC,the radiation ability of AMI diagnosis and treatment in the Second Hospital of Hebei Medical University is strengthened,the mortality rate has a downward trend,and the treatment effect of AMI has initially shown.However,patient education and reperfusion therapy still need to be further optimized.