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This paper summarized the development status and shortcomings of the nursing field of chest pain center in China′s regional collaborative mode from four aspects, including the construction status of nursing staff, nursing quality control methods, nursing information construction, and nursing construction problems of chest pain centers in regional collaborative mode, so as to provide theoretical reference for the further standardized construction of nursing units in chest pain centers.
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Objective:To investigate the effects of chest pain center construction in basic-level hospitals on treatment time and short-term prognosis in patients with acute ST-elevation myocardial infarction.Methods:A total of 162 patients with acute ST-elevation myocardial infarction who received percutaneous coronary intervention (PCI) in The First People's Hospital of Jiande between November 2014 and November 2018 were included in this study. Among them, 66 patients who received treatment in The First People's Hospital of Jiande between November 2014 and October 2016 were included in the control group. The remaining 96 patients who received treatment between November 2016 and November 2018 were included in the study group. The underlying diseases, PCI success rate, first medical contact-to-balloon time, door-to-balloon time, in-hospital mortality, incidence of heart failure on the next day of PCI, length of hospital stay, hospital medical cost were retrospectively analyzed.Results:There were no significant differences in underlying disease composition ratio and PCI success rate between the two groups (both P > 0.05). There were significant differences in first medical contact-to-balloon time [(185.2 ± 53.7) minutes vs. (108.6 ± 46.4) minutes, t = 6.128], door-to-balloon time [(121.5 ± 23.2) minutes vs. (68.7 ± 14.3) minutes, t = 7.341], length of hospital stay [(10.3 ± 3.5) days vs. (7.2 ± 2.8) days, t = 5.128], hospital medical cost [(43 582.0 ± 7 186.5) yuan vs. (35 479.0 ± 4 213.1) yuan, t = 8.361], in-hospital mortality [6.1% vs. 3.1%, χ2 = 4.784], the incidence of heart failure on the next day of PCI [13.6% vs. 4.2%, χ2 = 8.253] between the control and study groups (all P < 0.05). Conclusion:Establishment of a standardized chest pain center construction in basic-level hospital can greatly shorten the first medical contact-to-balloon time, door-to-balloon time and length of hospital stay, improve the cardiac function and prognosis of patients with myocardial infarction, and reduce medical cost.
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@#Objective To investigate the effectiveness of establishment of chest pain center and optimized process in the diagnostic and treatment progress and short-term prognostic value of acute non-ST segment elevation myocardial infarction (NSTEMI) patients. Methods This was a retrospective study. We included NSTEMI patients admitted in the Emergency Department in our hospital, 41 patients admitted before the establishment of the chest pain center (April 2015) were included as group A (30 males and 11 females at age of 64.7±11.8 years), 42 patients after the establishment of the chest pain center (April 2016) as group B (31 males and 11 females at age of 64.6±11.8 years), and 38 patients after the establishment of the chest pain center (April 2017) as group C (30 males and 8 females at age of 62.6±10.0 years). The clinical outcomes of the three groups were compared. Results The time from admission to electrocardiogram was 20.0 (17.0, 25.5) min in the group A, 4.0 (2.8, 5.0) min in the group B, and 3.0 (2.0, 4.0) min in the group C (P<0.001). The first doctor's non-electrocardiogram advice time was 13.0 (10.0, 18.0) min, 9.5 (6.8, 15.3) min, and 9.0 (7.0, 12.0) min (P=0.001) in the three groups, respectively. The diagnostic confirmed time was 139.4±48.5 min, 71.1±51.5 min, 63.9±41.9 min (P<0.001). The proportion of patients receiving emergency dual anti-platelet load dose treatment was 53.1%, 70.0%, 100.0% (P=0.001), respectively. The time of receiving emergency dual anti-platelet load dose treatment was 208.0 (72.0, 529.0) min, 259.0 (91.0, 340.0) min, and 125.0 (86.0, 170.0) min (P=0.044) in the three groups, respectively. Emergency percutaneous coronary artery intervention (PCI) start time was 60.9 (42.1, 95.8) hours, 61.3 (43.3, 92.2) hours, 30.5 (2.8, 44.1) hours (P<0.001) in the three groups, respectively. Among them, the moderate risk patients’ PCI starting time was 63.0 (48.1, 94.2) hours, 62.3 (42.1, 116.2) hours, and 40.1 (17.2, 60.4) hours (P>0.05), respectively. The high risk patients’ PCI starting time was 47.9 (23.7, 102.4) hours, 55.2 (44.0, 89.6) hours, 23.2 (1.7, 41.8) hours in the three groups, respectively (P<0.001). The hospitalization time of the patients was 7.0 (5.4, 9.4) days, 5.9 (4.9, 8.7) days, 4.7 (3.1, 6.2) days in the three groups (P<0.001), respectively. The hospitalization time of the moderate risk patients was 6.9 (4.9, 8.8) days, 6.4 (4.9, 8.0) days, 4.8 (3.2, 6.5) days in the three groups (P>0.05), respectively. The hospitalization time of the high risk patients was 7.1 (5.5, 9.9) days, 5.9 (4.6, 9.8) days, and 4.4 (3.0, 6.1) days, respectively (P<0.001). The fatality rate of inpatients was 4.9%, 0.0%, and 0.0%, respectively (P>0.05). The correlation coefficient of hospitalization time, diagnosis confirmed time and PCI starting time was 0.219 and 0.456 (P<0.05), respectively. Conclusion The establishment and optimized process of chest pain center can accelerate the time of early diagnosis of NSTEMI, which is helpful to obtain stratified and graded standardized treatment for patients according to their conditions, to accelerate the specific treatment process of high risk NSTEMI patients, and shorten the hospitalization time.
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Objective To explore the effects of target value management for quality control indexes in chest pain center on the efficiency and effectiveness of in-hospital treatment for STEMI patients.Methods The database of Chest Pain Center in General Hospital of Guangzhou Military Command was retrospectively analyzed.STEMI patients who visited our hospital from March 2011 to March 2018 were selected as the research subjects.During the review period,the target values of quality control indexes were adjusted 4 times.Before and after the 4 adjustment,the efficiency indexes of in-hospital treatment STEMI patients were compared,including the first medical contact to the first electrocardiogram (FMC2ECG) time,catheter lab activation time and Door-to-Balloon (D2B) time.Length of hospital stay,in-hospital mortality and hospitalization cost were compared as well.Results A total of 332 STEMI patients were included in the study.As the quality control target values became stricter,the median and the average value of FMC2ECG time,catheter lab activation time and D2B time showed a downward trend.Among these data,the D2B time decreased from 95 (74,134.5) min to 50 (44.5,71) min,and its differences were of the most significance.However,there is no significant difference in the hospitalization cost,length of hospital stay and in-hospital mortality of STEMI patients.Conclusions The target value management of quality control indexes can improve the in-hospital treatment efficiency for STEMI patients,but the improvements of treatment efficiency and effectiveness cannot be immediately revealed.It takes a certain amount of time and needs enough cases to reach a significant difference.
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ObjectiveTo compare the treatment of acute ST-elevated myocardial infarction (STEMI) before and after the certification of chest pain center model, so as to provide reference for the construction of chest pain center. Methods We retrospectively analyzed the clinical data of patients with acute STEMI before and after certification of the chest pain center of Shanghai General Hospital of Shanghai Jiao Tong University. Totally 119 patients were included in the pre-certification group from January 2017 to December 2017, and 160 patients were included in the post-certification group from January 2018 to April 2019. The baseline data, first medical contact to electrocardiogram (ECG) time, first ECG confirmation time, troponin reporting time, cath lab activation time, door-to-balloon dilation time, hospitalization stay, hospitalization drug cost, hospitalization inspection cost, hospitalization examination cost, total hospitalization cost, and outcomes were compared between the two groups. Results There was no significant difference in the gender, age, history of hypertension or history of diabetes between the two groups (all P>0.05). The cath lab activation time was not significantly different between the two groups (P>0.05). The first medical contact to ECG time (Z?-7.247, P0.05). Conclusion Through the certification and standardized operation of chest pain center, the time of treatment for acute STEMI can be significantly shortened.
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Objective: To analyze and design the information system of chest pain center so as to improve the overall treatment level for patients with chest pain in emergency department,and to shorten the waiting time of diagnosis and treatment after they achieved hospital.Methods: Using 4G network,internet of things,virtual private dial-up networks(VPDN)and information system of chest pain to send real-timely medical data of patient from ambulance to hospital.And then doctors of electrocardiographic room,emergency department and cardiology department implemented analysis report,first-aid guidance,preparation of surgery and treatment and other series of operation.Results: Patient's condition has been preliminarily confirmed before they arrived the hospital,and the doctors has completed preparation of interventional operation.When the patient arrived at the hospital,he could directly were sent into the catheterization room to receive treatment but need not be confirmed again by emergency room.Conclusion:This system can supplement the shortage of technical force of pre-hospital first-aid team,and shorten the treatment time of patients with chest pain,and improve the success rate of rescue.
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Objective To analyze the effectiveness and safety of chest pain centers in the management of patients with acute chest pain.Methods The clinical data of 315 patients with acute chest pain who presented to the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine from January 2012 to December 2016 were retrospectively analyzed.The chest pain center of our hospital was established in December 2014.A total of 123 patients with acute chest pain who were treated before the establishment of the chest pain were included as the control group.From December 2014 to December 2016,192 patients with chest pain were admitted and included as the observation group.The percentages of acute myocardial infarction and patients receiving emergency intervention(percutaneous coronary intervention,PCI),the door-to-balloon(D to B)time,average length of hospital stay and rates adverse events between the two groups were compared.Results The percentages of acute myocardial infarction among patients with acute chest pain was 75.6％in the control group and 82.3％in the observation group(P=0.027).The emergency PCI rate was 83.9％in the control group and 92.4％in the observation group(P=0.001).The door-to-balloon time was(64.12±34.76)min in the control group and(58.08±16.26)min in the observation group(P=0.025).The average length of hospital stay was(10.09±4.03)days for the control group,and(7.41±3.78)days for the observation group(P=0.025).There was no statistical difference in the incidence of recurrent myocardial infarction between the 2 groups(P＞0.05).The rates of sudden cardiac death,heart failure,cardiogenic shock and adverse events were all significantly higher in the control group(all P＜0.05).Conclusions The establishment of chest pain center provides safer and more effective treatment to patients with acute chest pain.
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Objective To investigate the effect of first aid nursing path under the center of chest pain on the diagnosis and treatment of patients with ST-segment elevation myocardial infarction (STEMI). Methods A total of 79 cases of STEMI patients who had been selected for emergency treatment after the establishment of the chest pain center were as the experimental group. The patient's first aid nursing path was used in the center of chest pain. A total of 159 cases of STEMI patients before the establishment of the chest pain center were as the control group, Application of traditional clinical pathway. Compared to the diagnosis and treatment effect of two groups of patients. Results The rate of completed the project within 10 min for the experimental group: the completion of electrocardiogram examination (91.1% vs 84.9% ), oral aspirin, clopidogrel, or lindinda (81.0% vs 75.5%), and laboratory medical order (79.7% vs 69.8%) were higher than those in the control group, and the difference was statistically significant (χ2=2.31, 1.68, 2.06, P < 0.05). The day of hospitalization in the experimental group was less than that of the control group (6.48±3.82 vs 9.76± 4.32), and the difference was statistically significant (t=-9.80, P < 0.05). The mortality rate during hospitalization was lower than that of the control group (5.66% vs 3.8% ), and the difference was statistically significant (χ2=-2.24, P<0.05). Conclusion The first aid nursing path in the center of chest pain can shorten the time of diagnosis and treatment of STEMI patients and improve the diagnosis and treatment effect of STEMI patients.
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Objective To investigate the effect of optimizing nursing process in emergency PCI on the reduction of radiation received by interventional nurses.Methods A total of 100 cases of acute myocardial infarction patients who need emergency PCI in First Affiliated Hospital of University of South China were selected for the study,with the first 50 cases as the control group using conventional nursing process and the other 50 cases as the optimization group using the optimal nursing process in the test.Two radiation monitoring methods were used at the same time to measure,record and analyze the radiation dose to the intervention nurses in the two groups.Results The differences in radiation doses to nurses between the two groups were statistically significant in the single operation of intracoronary drug configuration,non-intracoronary drug configuration,intravenous injection,patient care,emergency material unpacking,and contrast agent replacement (Z =-5.171,-3.774,-7.208,-2.454,-4.516,-3.819,P ＜ 0.05).There was no significant difference in radiation dose to nurses between the two groups in the subcutaneous injection of drugs and vomiting care of patients (P ＞ 0.05).The difference in radiation doses to nurses between the two groups during the entire operation was statistically significant (Z =-6.105,P ＜ 0.05).Conclusions The optimized nursing process helps to reduce the radiation received by interventional nurses in emergency PCI.
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Objective To investigate the influence of the establishment of Chest Pain Center (CPC) on the reperfusion treatment and prognosis of patients with acute ST segment elevated myocardial infarction (STEMI).Methods One hundred and eighteen patients with acute STEMI admitted into the Department of Emergency in Weifang People's Hospital from March to May 2016 before the establishment of the CPC were assigned as a control group,and 112 patients with STEMI admitted from September to November 2016 after the establishment of CPC were assigned as a study group.The first electrocardiograph (ECG) of all emergency patients was finished by nurses in the control group,after the cardiology physicians of Emergency Department having examined the patients,those with definite diagnosis of acute STEMI were sent into a resuscitation room immediately,and a loading dose of aspirin 300 mg and ticagrel 180 mg were given orally to each of the patients.The patients who accepted the primary percutaneous coronary intervention (PPCI) were transferred into a catheterization room as soon as possible;the patients who could not accept the PPCI,after the exclusion of contraindications of thrombolysis,were transferred into the emergency intensive care unit (EICU) to receive the intravenous thrombolytic treatment.For the study group,a uniform training was implemented,including the ECG interpretation,the diagnosis and treatment processes of chest pain for all of the medical staff,and establishment of a CPC database.The patients who were diagnosed as acute STEMI entered into the green channel of chest pain.For the patients who accepted the PPCI,the catheterization room was started immediately.The patients who could not accept the PPCI received the intravenous thrombolysis treatment:intravenous drip of urokinase 1 500 kU dissolved in 100 mL physiological saline was finished in 30 minutes.After treatment,the differences in the time from symptom onset to first medical contact (SO-to-FMC),the finished time of the first ECG after admission,the time of visiting doctor to reperfusion treatment[beginning of thrombolysis or ballon dilatation (DTRT)] including the door-to-needle (D2N) time or the doorto-balloon (D2B) time,the incidence of heart failure during hospitalization,the left ventricular ejection fraction (LVEF) measured with color Doppler ultrasound on the 7th day after admission and the in-hospital mortality were compared between the two groups of patients.Results There was no statistically significant difference between the study and control groups in the SO-to-FMC time (minutes:140.3 ± 108.4 vs.139.4 ± 112.7,P ＞ 0.05).The finished time of the first ECG after admission in the study group was significantly shorter than that of the control group (minutes:7.7 ± 1.3 vs.8.9 ± 1.7,P ＜ 0.05),the door to reperfusion time in the study group was also significantly shorter than that of the control group [D2B (minutes):72 ± 13 vs.83 ± 17,D2N (minutes):27 ± 9 vs.33 ± 12,both P ＜ 0.01].The incidence of heart failure during hospitalization of the study group was significantly lower than that of the control group [40.2％ (45/112) vs.53.4％ (63/11 8)].The left ventricular ejection fraction (LVEF) measured at one week after admission in study group was significantly higher than that of the control group (0.54 ± 0.05 vs.0.53 ± 0.04,P ＜ 0.01).The in-hospital mortality of the study group was lower than that of the control group [9.8％ (11/112) vs.14.4％ (17/118)],but there was no statistically significant difference between the two groups (P ＞ 0.05).Conclusion The application of the CPC run mode can further elevate the therapeutic level of reperfusion therapy,shorten the total ischemic time and improve the prognosis of patients with STEMI.
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Objective To investigate the impact of the regional cooperative chest pain center (CPC) on therapeutic time and short term outcome after primary percutaneous coronary intervention (PCI) of patients with ST segment elevated myocardial infarction.Methods 372 patients with ST segment elevated myocardial infarction were enrolled in the study who had received were operated primary PCI 18 months before and after the regional cooperative CPC was set up.There were 156 patients in the green channel group before the setup of CPC and 216 patients in the CPC group.Total ischemia time,first medical contact (FMC) time,FML-to-balloon (FMC2B) time,door-to-balloon (D2B) time,hospital mortality rates,cardiac failure rates on the next day after PCI,length of CCU stays and hospital stays were compared between the two groups.Results Compared to the green channel group,total ischemia time[(281.0±102.7)min vs.(365.2±115.6)min,P＜0.05],FMC time [(174.3±97.5) min vs.(225.4±104.6) min,P＜0.05],FMC2B time [(106.7±61.2) min vs.(139.8±75.7) min,P＜0.05] and D2B time [(75.2±45.4) min vs.(102.4±53.7) min,P＜0.05] of the CPC group were significant shorter.The rates of reaching the standard of FMC2B time (70.83％ vs.34.62％,P＜0.001) and D2B time (75.93％ vs.40.38％,P＜0.001)were significantly higher in the CPC group.Cardiac failure rates on the next day after PCI was lower in the CPC group (14.35％ vs.23.72％,P=0.021),and CCU stays was shorter [(64.3±13.72)h vs.(92.6±15.65)h,P=0.043].Conclusions Establishment of a standardized regional cooperative CPC requires combination and consideration of the characteristics of local resources FMC2B time and D2B time of STEMI patients can be shorten by a standardized CPC lending to further shortening of total ischemia time and improvement in cardiac function.
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Objective To investigate the effects of rapid response system of chest pain on the short-term and long-term prognosis of patients with acute ST segment elevation myocardial infarction (STEMI).Methods Referring to the international association of chest pain centers,the chest pain center was established in this hospital,and the corresponding management system and treatment process were worked out.A total of 374 acute STEMI patients who were recruited as the observation group were admitted to this hospital after the establishment of the chest pain center (December 2014 to June 2016),and 250 STEMI patients admitted before the establishment of the chest pain center (January 2012 to December 2012) were recruited as control group.Patients in observation group were treated in the chest pain center,and those in control groupreceived conventional treatment.The general situation,basic diseases,the finishing time of the first electrocardiogram(ECG),the time of door-to balloon expansion(D2B),the time of hospital stay,the average hospitalization expenses,in-hospital cardiac events and in-6-month cardiac events were compared between the two groups.All patients were followed up for 1 years,left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter (LVEDD),left ventricular aneurysm,B type natriuretic peptide (pro-BNP),serum creatinine (Scr),C-reactive protein (CRP) levels and adverse cardiac events (heart failure,death,readmission rate etc.)were compared between two groups.Results Compared with the control group,the average completion time of the first electrocardiogram in the observation group was shortened (P=0.001),the time of entry balloon dilatation,the time of hospital stay,the average hospitalization expenses were less than that of the control group (P＜0.05),the adverse cardiac events (hospital death and heart failure) were lower in the observation group than in the control group (P＜0.05).After 6 months of follow-up,LVEF was significantly higher in the observation group than in the control group (P＜0.05).the levels of LVEDD,pro-BNP,CRP and adverse cardiac events in the observation group were significantly lower than those in the control group (P＜0.05),there was no significant difference in the formation rate of ventricular aneurysm and Scr between the observation group and the control group (P＞0.05).After 1 year of follow-up,LVEF was still higher in the observation group than in the control group (P＜0.05).The incidence of LVEDD,pro-BNP,CREA,CRP,left ventricular aneurysm formation rate,the incidence of adverse cardiac events were lower in the observation group than in the control group (P＜0.05).Conclusion The establishment of rapid response system of chest pain treatment not only effectively shortenthe treatment time of STEMI patients,improve the treatment efficiency,shorten the hospital stay,reduce the cost of hospitalization,but also improve the quality of life and disease prognosis.
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Xiamen Cardiovascular Hospital set up the first chest-pain center in Fujian province,and launched the first citywide regional chest pain network in China.Their experiences prove that the first-aid network can effectively integrate ambulances,primary hospitals,general hospitals,and special hospitals for seamless connection between EMS and in-house rescue.These efforts can minimize the mortality and disabilities of myocardial infarction,effectively elevating the myocardial infarction treatment efficiency and capabilities of the region.
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Objective To evaluate the role of establishment of the chest pain center in the treatment of patients with acute ST-elevated myocardial infarction (STEMI). Methods Referring to the international association of chest pain centers, the chest pain center was established in the hospital the authors served, and the corresponding management system and treatment process were worked out. A total of 576 patients with acute STEMI, admitted after the establishment of the chest pain center (May 2015 - Mar. 2016), were recruited as the observation group, and 512 STEMI patients admitted before the establishment of the chest pain center (Jan. - Dec. 2014) were enrolled as control group. Patients in observation group were treated in the chest pain center, and those in control group received conventional treatment. The general situation, basic diseases, the finishing time of the first ECG and the completed number of ECG within 10 minutes, the success rate of stent implantation in percutaneous coronary intervention (PCI), the time of door-to balloon expansion (D2B), the length of hospital stay and in-hospital mortality were compared between the two groups. Results No significant difference existed between the two groups in the species composition of diseases, age and sex. The average finishing time of the first ECG was shorter in observation group than in control group (P=0.001), the success rate of stent implantation in PCI was higher in observation group than in control group, but without statistical significance (P=0.222). The time of D2B and of hospital stay was shorter in observation group than in control group (P0.05). Conclusion The establishment of the chest pain center may effectively shorten the rescue time for patients with STEMI, improve the efficiency of treatment and shorten the length of hospital stay, and is worthy of further clinical promotion.
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Clinical predictors of ST-segment elevation myocardial infarction (STEMI) patients may guide clinicians to select the type of treatment. Four articles published in present issue made an in-depth analysis of the data collected recent years from Cardiovascular Intervention Procedures Database of Chinese military hospitals, explored the effects of gender, preoperative severity of target-vessel stenosis, establishment of chest pain center and intra-aortic balloon pump on in-hospital mortality of STEMI patients, which may be helpful for clinicians to individualize treatment, further optimize reperfusion strategy, and improve the clinical efficacy and the prognosis of STEMI patients.
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Objective A retrospective analysis were conducted to identify the effect of bypassing the emergency department on 30-days outcomes of patients with acute myocardial infarction undergone primary percutaneous coronary intervention ( PPCI) . Methods From June 2014 to April 2015, 187 patients underwent PPCI in Kunming General Hospital were included. 13 patients were excluded owing to their incomplete follow-up data. The total 174 patients were divided into two groups: the control group (n =59) who did not bypass the emergency department, and the bypass group ( n = 115) who bypassed the emergency department and directly received PPCI. The data of all patients were collected and analyzed. Results There were no significant differences in baseline characteristics and PPCI related data (including percentage of thrombus aspiration catheter used, length or diameter of stents applied between two groups (all P ﹥ 0. 05) . The bypass group had shorter door-to-ballon ( D2B) than the control group [ (67. 7 ± 21. 5) min vs. (89. 4 ± 23. 6) min, P ﹤ 0. 001] . There were no significant differences in 30-days all-cause mortality, re-myocardial infacrtion and target ressel revascularization (TVR) between the two groups (P ﹥ 0. 05) . Total MACEs rate in the bypass group was lower than in the control group (10. 2% vs. 1. 7% , P = 0. 012) . Logistic regression analysis showed that age, diabetes, pain-to-door (PTD) time and CK peak value were the main influencing factors for 30-day MACEs rate of patients receiving PPCI ( P ﹤0. 05) . Conclusions Bypassing the emergency department can shorten D2B time and reduce 30-days MACEs post-PPCI, but reducing the total ischemic time will be more beneficial to patients with acute myocardial infarction.
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Objective This study intends to explore the impacts of the establishment of chest pain center(CPC) on the door-to-balloon(D-to-B) time in patients with ST-elevation myocardial infarction (STEMI) by different transfer ways to hospital. Methods A regular CPC and a regional cooperative network were established based on the pre-hospital transmitted real-time 12-lead electrocardiogram system. The STEMI patients were divided into the following three groups by the different transfer ways to hospital before and after the establishment of chest pain center:self-referral groups (group A1, n=52, and group A2, n=65), EMS (emergency medical service ) groups (group B1, n=31, and group B2, n=92) and transfer PCI groups (group C1, n=23, and group C2, n=552). The mean D-to-B time and the rate of D-to-B below 90 minutes were compared between before and after the establishment of CPC and the reasons of reperfusion delay were analyzed. Results There were no statistical differences of the average D-to-B time [(123±78) min vs.(140±123)min, P > 0.05] and the rate of D-to-B time below 90 min (44.2%vs. 46.2%) between group A1 and group A2. The average D-to-B time was significantly shortened in group B2 [(89±66)min] while compared with that in group B1 [(155±115)min, P<0.05] and the rate of D-to-B time below 90 min was remarkably elevated in group B2 compared with that of group B1 (69.6%vs. 32.3%, P<0.05). The average D-to-B time was significant shorter in group C2 than in group C1 [(77±43)min vs. (337±662)min, P<0.05] and the rate of D-to-B time below 90 min was remarkable higher in group C2 than in group C1 (75.7%vs. 21.7%, P<0.05). The longer D-to-B time in self-referral groups was mainly due to the delay of getting informed consent before PCI when occupied catheterization laboratory was the major cause of reperfusion delay in EMS groups and transfer PCI groups. Conclusions The establishment of CPC may significantly shorten the D-to-B time and increase the rate of D-to-B time below 90 min for these patients admitted by EMS and transferred from non-PCI hospitals. However, the pathway for the self-referral patients should be further modified.
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Objective To study the efficiency of tele-consultation on Internet with transmitting realtime 12-lead ECG carried out by the Chest Pain Center evaluated by the length of time required for the emergency percutaneous coronary intervention (PCI) in patients with ST segment elevation myocardial infarction (STEMI).Methods A total of 435 STEMI patients treated by emergency PCI were divided into the group A (n =98,admitted in 2010),group B (n =114,admitted in 2011) and group C (n =223,admitted in 2012).Data were collected before (2010) and after establishment of the Chest Pain Center (2011 to 2012) including the length of time elapsed from onset of symptoms to the first medical contact (FMC),the length of time required from FMC to the intra-aortic balloon inflated (FMC-2B) and the length of time required from entering the gate of hospital to the intra-aortic balloon inflated (D-2B).Measure data were described with non-normal median and interquartile intervals.Comparisons were made among groups with rank sum test.Results The median time of D2B of three groups were 107,78 and 59 mins in groups A,B and C,respectively.The differences in D2B among three groups were significant (P =0.000).The time of the D2B was shortened significantly because of the patients transferred to the hospital with a variety of ways (P =0.008).However,the length of D2B time was not significantly changed (P =0.846) when patients came to the hospital all on themselves.The median times from symptom onset to FMC in the group A,group B and group C were 112,62 and 78 mins.and the differences among three groups were not statistically significant (P =0.368).The median times of FMC2B in three groups were 287.0,313.5 and 421.8 mins,respectively,and there were no significant differences (P =0.135).Conclusions The establishment of the Chest Pain Center and Internet of things can effectively shorten the duration of D2B in STEMI patients.However,the reduction of time length from the symptom onset to reperfusion must rely on the coordination between communities and health care system.