The impact of chest pain treatment unit on the key time points for the treatment of acute ST-segment elevation myocardial infarction and short-term prognosis
Objective To analyze the impact of the three bypassing strategies(bypassing chest pain treatment unit,emergency department,and Cardiac Care Unit)selected in chest pain center construction on the critical time nodes and short-term prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI)through a retrospective investigation of the chest pain center database.Methods Patients with STEMI admitted to the Cangnan County Chest Pain Center from October 2019 to September 2023 were selected.According to whether the patient′s hometown had a chest pain treatment unit,patients were mainly selected for emergency primary percutaneous coronary intervention(PPCI)through three bypass and Direct digital subtraction angiography(DSA)room,divided into observation group and control group.General data of STEMI patients,key time nodes such as arrival mode,time from symptom onset to first medical contact(SO-to-FMC),time from first ECG completion to bedside troponin completion,informed consent time for reperfusion,door-to-wire time(D-to-W),length of hospital stay,total hospitalization expenses,left ventricular ejection fraction(LVEF)during hospitalization,incidence of heart failure,30-day and 3-month case fatality rate were analyzed and compared between the two groups.Results A total of 319 STEMI patients were included in the study database.There were more male patients in both groups than female patients,and there was no significant difference in the mean age between the two groups.The self-arrival mode was mainly used in both groups,and there were differences in the numbers and proportions of patients who called 120,transferred,and self-arrived between the two groups,with statistically significant differences(χ2=5.613,4.972,5.144,P<0.05).There were significant differences in SO-to-FMC,ECG completion time,D-to-W,informed consent conversation time(t=3.033,4.974,4.362,4.079,P<0.05),and troponin time between the two groups,while there was no significant difference in the time of catheter activation(P>0.05).The proportion of cases rejected for PPCI in the observation group was significantly lower than that in the control group,with a statistically significant difference(χ2=5.107,P<0.05).The length of hospital stay and total hospitalization expenses in the observation group were significantly reduced compared with those in the control group(P<0.05).The LVEF during hospitalization in the observation group was higher than that in the control group,and the incidence of heart failure,30-day and 3-month case fatality rate were significantly lower than those in the control group(t=5.673,χ2=3.134,3.201,4.019,P<0.05).Conclusion The establishment of a chest pain treatment unit requires selecting three bypass strategies to perform PPCI.By selecting correct arrival methods,shortening SO-to-FMC time,ECG completion time,D-to-W time,informed consent conversation time,etc.,key time nodes can be shortened to reduce the total ischemic time of STEMI patients,improve LVEF during hospitalization,reduce the incidence of heart failure,reduce length of hospital stay and total hospitalization expenses,reduce 30-day and 3-month case fatality rate,thereby improving the short-term prognosis of STEMI patients.
维普
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