The Impact Of Chest Pain Center Construction On The Treatment Of Patients With Acute ST-segment Elevated Myocardial Infarction

[Objective]:To investigate the impact of chest pain center construction on refutation time,economic indicators and recent prognosis to the patients with acute ST-segment elevated myocardial infarction.[Methods]:A regular chest pain center（CPC）was established according to the certification standard of Chinese chest pain center and the clinical data of STEMI patients undergoing primary percutaneous coronary intervention（PPCI）were retrospectively analyzed between January 1st 2015 and December 31 st 2017.Divided the patients which included in the research into three groups by the startup time of CPC construction and the time of getting certification:group A（pre-CPC,90 cases）,group B（during-CPC,80 cases）and group C（post-CPC,132 cases）.Basic information,the angiography results of PPCI,door-to-balloon time（D2B）,symptoms-to-balloon time（S2B）,the incidence of in-hospital heart failure and mortality,duration of hospital stays,hospitalization expenses and the results of echocardiography were compared between the three groups.Furtherly,the patients included in the research were divided into two groups:with or without heart failure.D2B time,S2B time and hospitalization expenses were compared between them.[Results]:After the establishment of CPC,the D2B time of group B[78.50（68.00,90.00）]and C[73.00（63.00,86.00）]was significantly shorter than the time of group A[A:96.50（79.75,110.00）](P_A-B<0.001,P_A-C<0.001).The D2B time of group C was also shorter than B(P_B-C=0.042<0.05).While the S2B time of three groups[A:268.00（197.00,451.00）,B:246.50（188.75,345.25）,C:222.50（166.50,310.00）]shows no statistical differences（P>0.05）.The incidence of in-hospital heart failure[A:23.3%,B:20%,C:17.4%（P>0.05）]and mortality[A:6.7%,B:4.7%,C:4.5%（P>0.05）]showed a trend of decline without a statistically significance.Hospitalization expenses was significantly reduced in group B[39963.69（36668.96,49086.00）]and C[39986.01（36793.20,49271.03）]compared with group A[47612.73（40599.35,55820.97）](P_A-B<0.001,P_A-C<0.001).However,there is no statistical differences in hospitalization expenses between group B and C（P>0.05）.The S2B time of patients with heart failure and hospitalization expenses were significantly increasedthanpatientswithoutheartfailure[274.00（228.00,345.00）vs230.00（167.25,325.75）,P<0.001;56658.77（44261.25,72803.26）vs40411.72（36915.77,48027.17）,P<0.001].But the D2B time between the two groups[82.00（69.50,100.75）,79.00（68.00,92.50）]shows no statistical differences（P>0.05）.[Conclusion]:The establishment of chest pain center can significantly shorten D2B time and reduce hospitalization.However,the S2B time and incidence of in-hospital heart failure and mortality showed no improvement yet.As a result,the regional collaborative rescue system should be improved furtherly.To shorten the S2B time and to improve the prognosis of patients with STEMI ought to be the ultimate goals of chest pain center construction.