Analysis On Quality Control Of STEMI Management Under Construction Of Chest Pain Center

Objective: To explore the effect of chest pain center certification on the treatment efficiency of STEMI patients,and to provide reference for the next development of chest pain center in the affiliated hospital of Zunyi Medical University.Methods: We collected the clinical data of 280 STEMI patients who were treated in the affiliated hospital of Zunyi Medical University from March 2016 to July 2017 and had the disease within 12 hours.With the accreditation date of chest pain center of affiliated hospital of Zunyi Medical University in November 2016 as the grouping time point,STEMI patients meeting the inclusion criteria were divided into the pre-accreditation group(n = 104)and the post-accreditation group(n = 176).Through statistical analysis of general baseline clinical data(including age,sex,smoking,hypertension,etc.),BNP,LEVF,admission route,incidence of MACE during hospitalization,Coronary angiography results,drug use during hospitalization,days of hospitalization,hospitalization expenses and related time nodes such as D2 B,FMC2B,S2 B,etc.Results: There was no statistically significant difference in baseline data of age,gender,hypertension,diabetes between the two groups(P > 0.05).There was no statistically significant difference between the two groups in the admission mode and the first medical contact mode(P > 0.05).After the certification,S2 FMC time and S2 B time of the patients decreased compared with before the certification,and the proportion of ECG remote transmission increased compared with that of the group before the certification,but the differences were not statistically significant(P > 0.05).There was no significant difference in the time from the diagnosis of STEMI to the drug administration and the proportion of direct access to catheter room(P >0.05).After the certification,FMC2 ECG time(Z =-5.631,P < 0.001),first ECG diagnosis time(Z =-3.562,P < 0.001),D2 B time(Z =-3.310,P=0.001),FMC2 B time (Z =-2.124,P < 0.005),DIDO time(Z =-2.421,P < 0.005),and catheter room activation time(Z =-2.877,P < 0.005)were shorter than before the certification(P <0.05),the difference was statistically significant.There were no statistically significant differences between the two groups in residence location,payment method of medical insurance,drug use during hospitalization,rate of automatic discharge,examination indicators,coronary angiography results,incidence of MACE and other indicators(P > 0.05).After the certification,the length of stay and hospitalization expenses of the patients were less than those of the pre-certification(P < 0.05),the difference was statistically significant.Conclusion: The standardized construction of chest pain center promoted by chest pain center certification can better improve the efficiency of pre hospital emergency and in hospital treatment,shorten the time of patients’ ischemia-reperfusion,enable more ACS patients to complete the early diagnosis and treatment work after the first medical contact within the time recommended in the guidelines,and also reduce the patient’s hospitalization time and cost.