Effect Of Symptom Onset-Balloon Time On Prognosis Of ST-Elevation Myocardial Infarction Patients Undergoing PPCI Via Referral Route

Objective: Analyzing the effect of symptom onset to balloon(SO-to-B)on prognosis of ST-segment elevation myocardium infarction patients undergoing the primary percutaneous coronary intervention(PPCI)via referral route,and compraring the influence of each quality control period on total ischemia time,to guide the continuous improvement of the referral process.Methods: A retrospective study of 202 patients with STEMI who underwent PPCI treatment from non-PCI hospitals from November 2015 to November 2017 are enrolled in the affiliated hospital of Hangzhou Normal University.Patients with STEMI who's SO-to-B time <395 min are divided into group A,a total of 123patients;patients with STEMI who's SO-to-B time?395 min are divided into group B,a total of 79 patients.Comparing two groups of clinical data,symptom onset to first medical contact(SO-to-FMC)time,door to balloon(D-to-B)time,first medical contact to balloon(FMC-to-B)time,ACC/AHA risk factors,coronary artery lesions,TnI and CK-MB peaks,BNP,LVEDD,LVEF,perioperative complications,in-hospital death,time of staying in hospital,hospitalization expenses,major adverse cardiac and cerebrovascular events(MACCE)in 1.5 years,cumulative 2.5-year mortality after procedure,assessment of the effect of SO-to-B time on the prognosis of patients with STEMI who underwent PPCI,and analyze the delay periods of the total ischemic time in the referral process,to provide a basis for optimizing the referral path.Results: There is no significant difference in the clinical data between two groups(P>0.05).The average time of SO-to-B in 202 patients with STEMI is 389 min.The SO-to-FMC time and FMC-to-B time in group B are significantly longer than those in group A(P<0.001),while there is no significant difference in D-to-B time(P>0.05).In the comparison of perioperative data between the two groups,the systolic blood pressure <100 mmHg and the Killip classification ? II ratio in the risk factors of ACC/AHA in group B are higher than those in group A(P<0.05).There is no significant difference in the number of diseased vessels(P>0.05).In the postoperative cardiac function index,the postoperative BNP of group B is higher than that of group A and the LVEF is lower than group A(P<0.05).Moreover,The perioperative complication rate and in-hospital mortality of group B patients are higher than those in group A(P<0.05).In the long-term prognosis comparison,the 1.5 years mortality of patients in group B is higher than that in group A(P<0.05).In the 2.5-yearpostoperative Kaplan-Meier survival curve,the cumulative mortality rate in group B is higher than that in group A(13.0% vs 2.9%),but the difference is not statistically significant(P=0.051,P>0.05).Analysis of risk factors for short-term and long-term prognosis showed that SO-to-B time is associated with perioperative complications,in-hospital death,and 1.5-year mortality in patients with STEMI after PCI.Conclusion: SO-to-B time is associated with high-risk stratification in STEMI patients who underwent PPCI via referral,and affects postoperative cardiac function,perioperative complications,in-hospital death,and 1.5-year postoperative mortality.FMC-to-B time is meaningful for reducing total ischemic time in STEMI patients,but D-to-B time has no effect on it,suggesting that network hospital response capacity and transport efficiency should be strengthened in the referral route to reduce system time delay.