胸痛中心区域救治体系对STEMI患者绕行急诊科行PPCI的应用研究

Application Study of Chest Pain Center Regional Treatment System for STEMI Patients to Bypass Emergency Department for PPCI

目的:总结基于胸痛中心区域救治体系对ST段抬高型心肌梗死(STEMI)患者绕行急诊科行直接经皮冠状动脉介入(PPCI)的临床效果。方法:以2019年3月至2021年3月就诊我院接受PPCI治疗并资料上传至国家胸痛中心数据平台的118例STEMI患者为研究对象,依据是否绕行急诊,将患者分为绕行组(58例)和非绕行组(60例),观察两组发病到首次医疗接触时间(S-to-FMC)、门球时间(D-to-B)与发病到球囊扩张血管时间(S-to-B),比较两组D-to-B达标率、住院天数、住院费用、院内主要并发症发生率、病死率、术后左室射血分数(LVEF)、随访主要心血管不良事件(MACE)发生率。结果:与非绕行组比较,绕行组住院天数、住院费用均无明显差异(P>0.05);绕行组S-to-FMC、D-to-B与S-to-B均明显短于非绕行组(P<0.05);绕行组术后LVEF明显增高,随访MACE发生率明显降低(P<0.05)。结论:基于胸痛中心区域救治体系对STEMI患者绕行急诊科行PPCI,可有效缩短患者救治时间,减少MACE发生率,改善预后。

Objective: To summarize the clinical effect of direct percutaneous coronary intervention(PPCI)for patients with ST-segment elevation myocardial infarction(STEMI)bypassing the emergency department based on the central regional rescue system for chest pain. Methods:118 patients with STEMI received PPCI in the hospital from Mar2019 to Mar 2021 and the data uploadedto the data platform of the National Chest Pain Center were divided into bypass group(n=58)and non-detour group(n=60)based on whether bypassed the emergency department. The time from onset to first medical contact(S-to-FMC),the time from goal kick(D-to-B)and the time from onset to balloon dilation(S-toB)were observed between the two groups. TheD-to-B compliance rate,hospitalization days,hospitalization expenses,major complications in the hospital,mortality rate,postoperative left ventricular ejection fraction(LVEF),and followup major adverse cardiovascular events(MACE)rate were compared between the two groups. Results:Compared with the non-detour group,the hospitalization days,hospitalization expensesin the bypass group was no significantly different,both P>0.05. S-to-FMC,D-to-B and S-to-B in the bypass group were significantly shorter than those in the non-detour group(all P<0.05). The postoperative LVEF in the bypass group was significantly higher than that in the non-detour group,while the follow-up MACE rate was lower than that in the non-bypass group(both P<0.05). Conclusions:PPCI bypassing the emergency department for STEMI patients based on the chest pain center regional treatment system can effectively shorten the treatment time of patients,reduce the incidence of MACE and improve the prognosis.