High-quality of emergency clinical pathway and therapeutic effect evaluation for PCI in AMI patients / 心血管康复医学杂志

ABSTRACT

Objective:To explore high-quality of emergency clinical pathway of percutaneous coronary intervention (PCI)in patients with acute ST elevation myocardial infarction (STEAMI),and systematically evaluate its clinical effect.Methods:A total of 627 STEAMI patients,who received successful emergency PCI from Mar 2008 to Sep 2016,were selected.According to hospitalization sequence,they were divided into traditional pathway group (n=298)and high-quality pathway group (n=329,received new clinical pathway strategy formulated by present study). Reperfusion time and level of infarct related artery (IRA),postoperative mortality,the 36-item short-form heath survey (SF-36)score at discharge,NYHA class and left ventricular ejection fraction (LVEF)on one month after PCI were counted and analyzed in two groups.Results:Compared with traditional pathway group,there were signif-icant reductions in door-to-balloon time [(86.3 ± 22.4)min vs.(65.9 ± 17.8)min]and onset-to-balloon time [(189.5±30.2)min vs.(154.6±27.2)min],and significant rise in percentage of TIMI ≥grade I of IRA before PCI (5.0% vs.25.5%)in high-quality pathway group (P <0.01 all),but there was no significant difference in per-centage of TIMI grade III of IRA after PCI between two groups,P =0.393. Compared with traditional pathway group,there were significant rise in total SF-36 score [(66.1±11.2)scores vs.(75.9±12.8)scores]at discharge and LVEF [(49.3±11.2)% vs.(54.1 ±13.6)%]on one month after PCI,and significant reduction in NYHA class [(1.97±0.65)classes vs.(1.68±0.51)classes]on one month after PCI in high-quality pathway group (P <0.05 or <0.01 ).There was no significant difference in postoperative mortality between two groups,P =0.803. Conclusion:High-quality emergency clinical pathway of PCI in STEAMI patients contributes to early reperfusion of IRA,shortens door-to-balloon time,significantly improves their clinical prognosis,which is worth extending.