The influence of establishment of Chest Pain Center on reperfusion therapy in patients with acute ST segment elevated myocardial infarction: a result of comparative study before and after establishment / 中国中西医结合急救杂志

ABSTRACT

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.