Effect of regional synergistic treatment system on the treatment time and short-term prognosis of ST-segment elevation myocardial infarction / 中华危重病急救医学

ABSTRACT

Objective To explore the effect of regional synergistic treatment system on the treatment time and short-term prognosis of patients with ST-segment elevation myocardial infarction (STEMI).Methods A retrospective analysis of the clinical data of STEMI patients who admitted to emergency center of Suzhou Kowloon Hospital Affiliated to Shanghai Jiaotong University School of Medicine and underwent primary percutaneous coronary intervention (PPCI) from January 2013 to January 2017 were conducted. All patients were divided into two groups, group A was the patients who underwent the PPCI before the establishment of the acute chest pain area co-treatment system (from January 2013 to December 2014), and group B was the patients who received the treatment after the establishment of the area co-treatment system (from January 2015 to January 2017). The length of time from onset of symptoms to the balloon dilatation (S2B), the length of time from the first medical contact to the balloon dilatation (FMC2B), the length of time from entering the gate of hospital to the balloon dilatation (D2B), and the incidence of 90-day end point events (including heart failure, all-cause death, and other related adverse events) were collected. The relations of the establishment of the acute chest pain area co-treatment system and the incidence of 90-day end point events were analyzed by multivariable Logistic regression analysis.Results Among the 221 enrolled patients with STEMI, 83 patients were in group A and 138 patients were in group B respectively. Compared with group A, S2B time [minutes 180 (140, 210) vs. 201 (154, 225)], FMC2B time [minutes 89 (78, 100) vs. 94 (83, 107)] and D2B time [minutes 66 (62, 70) vs. 85 (72, 99)] were significantly shortened in group B (allP < 0.05), the incidence of 90-day end point events were significantly decreased (heart failure20.3％ vs. 32.5％, all-cause death 1.4％ vs. 7.2％, other related adverse events 23.2％ vs. 36.1％, allP < 0.05). It was shown by multivariable Logistic regression analysis that the establishment of the acute chest pain area co-treatment system could lower the incidence of 90-day end point events [heart failure odds ratio (OR) = 1.904, 95％ confidence interval (95％CI) = 0.968-1.004, P = 0.048; all-cause deathOR = 11.724, 95％CI = 0.955-1.048,P = 0.013; other related adverse eventsOR = 1.925, 95％CI = 1.049-3.530,P = 0.034].Conclusion The construction of regional synergistic treatment system can shorten the emergency treatment time of STEMI patients and reduce the incidence of 90-day end point events including heart failure and death.