Study On Regional Cooperative Rapid Treatment System For Clinical Treatment Of STEMI Patients

Objective:To explore the effect of the regional cooperative rapid treatment system on the treatment efficiency and short-term prognosis of patients with acute STEMIMethods:This study relied on the treatment data of patients with acute STEMI before and after the operation of the regional cooperative rapid treatment system with the South Campus of the Sixth People’s Hospital,Shanghai Jiao Tong University as the treatment center,and the treatment data were retrospectively analyzed.Patients who received emergency PCI therapy for acute STEMI were selected as the control group from April 1,2017 to March 31,2018(n=84),and the patients with acute STEMI from April 1,2018 to March 31,2019 were selected as the experimental group(n=122)Patient’s clinical data,from onset to the first medical contact(S-FMC)time,from first medical contact to balloon dilatation(FMC2B)time,standard-reaching rate of FMC2B time,from onset to balloon dilatation(S2B)time,from entering hospital door to balloon dilatation(D2B)time,standard-reaching rate of D2B time,whether combined with adverse cardiovascular events rate were collected and compared.Results:There was no significant difference in gender,age,history of previous PCI,history of cerebral infarction,history of angina pectoris before infarction,history of hypertension,history of diabetes,history of smoking,BNP,blood lipid index and distribution of criminal vessels between the two groups(P>0.05).S-FMC and FMC2B were positively correlated with S2B[rs=0.947,95%CI(0.924,0.963),P<0.001;rs=0.496,95%CI(0.381,0.591),P<0.001].S-FMC,FMC2B and D2B were positively correlated with S2B in self-admission group and calling ambulance group(P<0.05),while only S-FMC and FMC2B were positively correlated with S2B in non-PCI hospital referrals(P<0.05).The time of S-FMC,FMC2B,S2B and D2B in the experimental group were shorter than those in the control group,while the proportion of ECG transmission through WeChat was higher,and the rates of adverse cardiovascular events were lower(P<0.05)Conclusion:The regional cooperative rapid treatment system can significantly reduce the S-FMC time,FMC2B time,S2B time,D2B time,and improve the FMC2B compliance rate and D2B compliance rate.The occurrence of adverse cardiovascular events is related to the treatment time.The regional cooperative rapid treatment system can improve the treatment efficiency of STEMI patients and reduce the incidence of adverse cardiovascular eventsFigure[4]table[9]reference[104]Objective:To explore the effect of coronary no-reflow phenomenon on the prognosis of acute ST segment elevation myocardial infarction and analyze the risk factors of coronary no-reflow phenomenon.Methods:From December 1,2013 to May 31,2019,618 patients with STEMI who underwent emergency PCI in the Department of Cardiology,The South Branch of the Sixth People’ s Hospital,Shanghai Jiaotong University were selected.According to the TIMI blood flow grading after PCI,the subjects were divided into two groups,522 in the normal blood flow group(TIMI 3)and 96 in the no reflow group(TIMI 0-2).General clinical data and angiography data were collected.Logistic regression was used to analyze the risk factors of CSFP,ROC curve was used to analyze the predictors of CSFP,and the area under ROC curve(AUC)was calculated.Results:The incidence of CSFP was 15.53%(96/618),In the no reflow group,the age,implantation of 2 or more stents,total stent length,post-stent dilatation,D-dimer level.NLR,the proportion of combined cardiogenic shock,hospital mortality and the proportion of LVEF<50%were significantly higher than those in the normal blood flow group(P<0.05,P<0.01).Logistic regression analysis showed that post-stent dilatation,cardiogenic shock and D-dimer level were independent risk factors of CSFP(P<0.05,P<0,01).The D-dimer level predicted CSFP had an AUC of 0.585(95%CI:0.521～0.649),post-stent dilatation predicted CSFP had an AUC of 0.558(95%CI:0.496～0.621).The combination of the two predicted had an AUC of 0.627(95%CI:0.567～0.687).The incidence and hospital mortality of CSFP in patients with high D-dimer were significantly higher than those in patients with low D-dimer(25.9%vs 12.3%,P<0.001;8.2%vs 1.9%,P<0.001).Conclusion:CNRP can cause left ventricular function impairment in STEMI patients and increase hospital mortality.D-dimer level,post-stent expansion,and cardiogenic shock are all independent risk factors for CNRP,and D-dimer level was a reliable marker of poor prognosis in STEMI.