The Trends Of Reperfusion Therapy And Process Improvement In Patients With Acute ST-segment Elevation Myocardial Infarction

Objective Clinical analysis of the reperfusion therapy trends in patients with acute ST-segment elevation myocardial infarction(STEMI) undergoing emergency percutaneous coronary intervention.Explore the influence factors of delay and procedures for improvement. Methods Bedside questionnaire,medical record information,electronic case file system and other relevant information is collected from Department of Cardiology of the First Affiliated Hospital of Fujian Medical University.The STEMI patients underwent emergency percutaneous coronary intervention were continuously collected from June 2014 to January 2016.Patients were divided into two groups according to the First Medical Contact-To-Balloon time(FMC-to-B time)≤120 minutes and >120minutes. Related factors were analyzed by chi-square test and logistic regression to determine independent factors which led to delay.Compare the therapeutic time by rank-sum test.Analyze the trends of every part of reperfusion time and contrast among the groups before and after the establishment of chest pain center.Combined with the data of CCC project,we will draw conclusions of whether our efforts to reduce reperfusion time are effective and summarise the experiences. Results Analysis of the interventional reperfusion time indicators:A total of 104 patients with STEMI were enrolled in this study.The independent factors of FMC-to-B time delay were transferred from other hospitals(P≤0.01) and presented during regular working hours(P<0.05).By analyzing the distribution of each time period,the time before FMC was significantly longer in patients with history of hypertension or chronic gastropathy.The time from FMC to our hospital was significantly longer in patients transferred from outside hospitals,patients presented during regular working hours and patients with diabetes.The Door-To-Balloon time(D-to-B time) of patients transferred from outside hospitals was significantly shorter than patients went directly to our hospital.The FMC-to-Balloon time was significantly longer in patients transferred from outside hospitals,patients presented during regular working hours, patients with diabetes and patients without history of surgery.The total ischemic time was significantly longer in patients transferred from outside hospitals,patients presented during regular working hours and patients without history of smoking. These differences were statistically significant(P<0.05).The main factors of the total ischemic time delay were associated with the time before FMC and the time from FMC to our hospital.In the past a year and a half,our D-to-B time was mainly reduced in the time from emergency department to Cardiology consultation and the time from reaching the catheterization laboratory to balloon.Our prehospital time was mainly delayed in the time before FMC.By comparing before and after the establishment of the center of chest pain,we found that every part of interventional reperfusion time was shortened obviously after the establishment of chest pain center except prehospital time.It led to no significant improvement in the total ischemic time. Results roughly matched the overall trend of the past a year and a half. The median guidelines(D-to-B time≤90min) achieved rate of our country floated between 50% to 66.67%. Conclusions 1.Transferred from other hospitals is the major delay of the FMC-to-B time.And it even showed growth trend. 2.After the founding of the chest pain center,each time period were significantly shortened in our hospital. But the time before FMC, FMC to our hospital, PDT were significantly longer than before.So there was no significant improvement in the total ischemic time. The outcomes were similar to the overall trend. 3.So we should strengthen cooperation and mutual assistance among hospitals.Set up comprehensive medical network system to shorten the distance between the patient and effective health care.The establishment of chest pain center has showed significantly positive effect.It should not be limited in third class A hospitals but also primary hospitals.