| BACKGROUNDCoronary heart disease is a serious disease which has a serious hazard for human healthy, especially acute coronary syndrome(ACS) is a common medical emergency and the main cause of death or disability in patients. The characteristic features of ACS are urgent suddenly, rapid progress and short effective treatment time. ACS includes acute myocardial infarction(AMI) and unstable angina pectoris(UA). According to the ST segment in ECG, AMI was divided into ST segment elevation myocardial infarction and non ST segment elevation myocardial infarction. AMI has high mortality rate, the incidence of AMI is increasing. The key treatment to AMI patients is revascularization by interventional therapy effectively and timely while the obstruction occurred in artery. STEMI patients can be diagnosed more easily and treated early because of the typical ECG changes. Based on the recently guidelines for diagnosis and treatment of STEMI revised by American Heart Association (AHA),European Society of Cardiology (ESC)and Chinese Medical Association, percutaneous coronary intervention(PCI) were recommended for STEMI patients as soon as possible in qualified hospital. Within 120minutes, Transfer for PCI or rescue-PCI after thrombolysis were recommended for those STEMI patients who were in qualified hospital and transferred from unqualified hospital. Researches shows that Emergency PCI can improve the prognosis of patients, reduce the mortality rate and decrease the cost of hospitalization if the treatment can be completed within 90minutes from the door to balloon (door to balloon, D2B), or the treatment can be completed within 120minutes from the first medical contact(FMC) to balloon. The establishment of society of chest pain centers made the diagnosis and treatment of chest pain process regulated in the United States, and it improved the treatment efficiency, reduced the mortality rate of AMI. Interventional technology is fast developed in China. However, hospitals with Primary PCI quality are mainly tertiary hospitals and great differences presented among different regions. Lack of communication among hospitals and people are impercipient about ACS make the average D2B time delayed, the Primary PCI rate fallen and the mortality of AMI not decreased significantly. In recent years, based on the advanced experience of foreign countries, the certification of China chest pain center by the Chinese Medical Association have been carried out to promote the construction of the chest pain center and shorten the gap between China and the advanced international level. Previous study demonstrated that chest pain center model in China can improve the prognosis of STEMI patients, shorten the hospitalization time, save the cost of hospitalization. To improve the treatment level of AMI and ACS, more and more chest pain centers will be built.OBJECTIVEThrough establishing the chest pain center of Taizhou People’s Hospital certified by China chest pain center to promote the standardization of diagnosis and treatment of ACS patients in Taizhou and improve the treatment efficiency of STEMI patients.METHODS1. Establish the chest pain center of Taizhou People’s Hospital certified by China chest pain center. To investigate the impact of the establishment of chest pain center(CPC) model for STEMI patients and evaluate the effect of this network.2. We evaluated the effects of chest pain center by retrospective study.149 STEMI patients were received as study group after the establishment of the chest pain center of Taizhou People’s Hospital (From September 2014 to August 2015).146 STEMI patients STEMI patients were received as control group before the establishment of the chest pain center of Taizhou People’s Hospital (From September 2013 to August 2014). We conduct contrastive analysis between the two groups. Furthermore, we also do subgroup analysis in study group.3.The demographic data, underlying diseases, ratio of pre-hospital delay more than 2 hours, pre-hospital treatment, admission form, cardiac function, in-hospital mortality, major adverse cardiac event(MACE)during the 6 months follow up and medical costs compared in patients before and after the establishment of the chest pain center of Taizhou People’s Hospital. The demographic data, underlying diseases, the mean D2B time, the mean FMC2B time, ratio of D2B and FMC2B time up to standard, in-hospital mortality, the short-term outcome, hospital days and medical costs were compared in Primary PCI patients before (Primary PCI study group)and after(Primary PCI control group) the establishment of the chest pain center of Taizhou People’s Hospital.RESULTS1. Compared with the control group, ratio of male patients, proportion of smoking and previous history of myocardial infarction were higher in study group. Ratio of patients came to hospital themselves dipped. The proportion of patients with call 120 increased[(31.5%,43.2%, p=0.039<0.05), (13.4%,4.1%, p=0.005<0.05)]. The rate of access from the onset of the disease to the first medical contact within 2 hours increased (55.7%,44.3%, p=0.042<0.05) Ratio of Pre hospital ECG increased (97.8%,2.2%, p<0.05). Dual antiplatelet therapy in non PCI hospital increased (48.3%,30.1%, p=0.001<0.05).Ratio of thrombolysis in non PCI hospital and Primary PCI in PCI hospital increased (12.8%,5.5%, p=0.03<0.05) (69.1%, 46.6%, p<0.05).The incidence of heart failure during hospitalization was significantly reduced in study group (3.4%,15.8%, p<0.05).Major adverse cardiac event rate ere significantly lower (2.7%,8.2%, p=0.036<0.05)2.The baseline data compared with Primary PCI study group and Primary PCI control group. There were no differences in gender, age, with hypertension, diabetes, hyperlipidemia, smoking, history of previous myocardial infarction and lesion-related vessels (left main coronary artery, right coronary artery, left anterior descending coronary artery and left circumflex coronary artery) (p>0.05). Compared with the Primary PCI control group,the patients presentation to hospital by self decreased in Primary PCI study group[21(26.9%),30(49.2%), p=0.007,p<0.05] and the patients transferred increased[4(65.4%),29(47.5%),p=0.035,p<0.05]; Emergency department bypass and CCU bypass increased[38 (48.7%),8 (13.1%), p<0.05];the annual mean D2B time was significantly shortened[(71.9+31.6)min, (115.3+45.4)min,p<0.05].The annual ratio of D2B below 90 minutes was significantly increased[64 (82.1%),17 (27.9%),p<0.05].The incidence of heart failure during hospitalization was significantly reduced in Primary PCI study group[2 (2.6%),8 (13.1%), p=0.040, p<0.05].The mean medical cost were significantly decreased [(41816.09±11914.50,47752.23±11214.56, p=0.003, p<0.05)].The average cost per person-coronary stent decreased[(38830.05±11063.70,47000.22±11037.95,p<0.05)].CONCLUSIONThrough the establishment of chest pain center for patients with STEMI, we made full use of the medical resources in Taizhou rationally, improved patients awareness of call pre-hospital aid system, improved early diagnosis and reperfusion treatment, decreased the D-to-B time,reduced the incidence of heart failure during hospitalization and reduced the average hospitalization expenses of Primary PCI patients. |
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