胸痛中心认证对急性ST段抬高型心肌梗死患者救治效率及预后的影响

The impact of chest pain center accreditation on the treatment effi ciency and short-term prognosis of patients with acute ST-segment elevation myocardial infarction

目的分析国内16家通过胸痛中心认证的三级甲等医院的数据,评价胸痛中心认证对行直接经皮冠状动脉介入治疗(PPCI)的急性ST段抬高型心肌梗死(STEMI)患者救治时间和近期预后的影响。方法从胸痛中心数据库平台提取16家医院,从开始建立胸痛中心至2019年12月31日收治发病12 h内且接受了PPCI的STEMI患者共计16449例,以各家医院通过胸痛中心认证的时间作为患者分组界限,将开始进行胸痛中心建设至通过认证前一天(建设期)收治的患者作为A组(4173例),通过胸痛中心认证后至2019年12月31日收治的患者为B组(12276例),比较两组患者的救治时间、院内心力衰竭发生率和死亡率。结果相比A组而言,B组患者发病至首次医疗接触(S-to-FMC)时间从120 min缩短至105 min[120(65,216)min比105(60,175)min,P<0.001],首次医疗接触至导丝通过(FMC-to-W)时间从159 min降至138 min[159(113,246)min比138(84,211)min,P<0.001],进门至导丝通过(D-to-W)时间从77 min降至60 min[77(55,100)min比60(45,79)min,P<0.001],发病至导丝通过(总缺血)(S-to-W)时间从323 min降至277 min[323(233,465)min比277(190,388)min,P<0.001]。STEMI患者的院内心力衰竭发生率从建设期的18.6%下降至认证后的13.4%(P<0.001),院内死亡率从建设期的3.6%下降至认证后的2.8%(P=0.010)。多因素Logistic回归分析显示,心力衰竭使STEMI患者死亡率增加15.8倍;S-to-W时间每延长1 h,STEMI患者死亡率增加2.2倍。结论胸痛中心认证工作显著缩短了接受PPCI的STEMI患者的救治时间,有效降低了STEMI患者的院内心力衰竭发生率及死亡率,未来应继续推动胸痛中心建设及认证。

Objective To assess the effect of chest pain center(CPC)accreditation on the treatment efficiency and short-term prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI)receiving primary percutaneous coronary intervention(PPCI)by analyzing the data of 16 domestic hospitals that have passed the certification of CPC.Methods A total of 16 hospitals from the CPC database platform were selected,including 16449 STEMI patients underwent PPCI within 12 hours from onset since the beginning of the establishment of CPC to December 31,2019.According to the time when each hospital passed the CPC accreditation,they were divided into group A(n=4173),from the beginning of the construction of the CPC to the day before the accreditation,and group B(n=12276),from the day of accreditation until December 31,2019.The treatment efficiency,in-hospital mortality and heart failure between the two groups were compared.Results Compared with group A,the symptom-onset-to-first-medical-contact(S-to-FMC)time decreased from 120 minutes to 105 minutes in group B[120(65,216)min vs.105(60,175)min,P<0.001],the FMC-towire crossing(FMC-to-W)time decreased from 159 minutes to 138 minutes in group B[159(113,246)min vs.138(84,211)min,P<0.001],the door-to-wire crossing(D-to-W)time decreased from 77 minutes to 60 minutes in group B[77(55,100)min vs.60(45,79)min,P<0.001],and the symptom-onset-to-wire crossing(S-to-W)time decreased from 323 minutes to 277 minutes in group B[323(233,465)min vs.277(190,388)min,P<0.001].The incidence of heart failure in STEMI patients decreased from 18.6%before accreditation to 13.4%after accreditation(P<0.001),and the rate of in-hospital mortality decreased from 3.6%before accreditation to 2.8%after accreditation(P=0.010).Multivariate logistic regression analysis showed that heart failure increased the mortality rate of STEMI patients by 15.8 times;for every one hour delay of total ischemic time,the mortality rate of STEMI patients increased by 2.2 times.Conclusions The CPC accreditation has significantly reduced the time to treatment and effectively reduced the incidence of heart failure and in-hospital mortality of STEMI patients undergoing PPCI.The construction and accreditation of CPC should continue to be promoted in the future.