Status And Causes Of Delay After First Medical Contact In Patients With Acute ST-elevation Myocardial Infarction

Objective:This topic mainly studies the current situation of delays from the first medical contact to balloon dilatation period in patients with acute ST-segment elevation myocardial infarction since the establishment of chest pain center in our hospital,finds out the problems of green channel and out-of-hospital collaborative treatment in our hospital,and puts forward solutions to the current problems.So we can find out a suitable model of chest pain center for our hospital.Method:From September 2017 to August 2018,clinical data of STEMI patients who underwent emergency PCI in the hospital of cardiovascular and cerebrovascular disease area affiliated to yan 'an university were analyzed.According to different ways of admission,PPCI patients were divided into self-admission group,call "120" admission group and transfer group.To compare whether there was any difference between the baseline data in the three groups in the way of admission,and to analyze the causes of the difference.Univariate anova or chi-square test were used to compare whether there were differences in the compliance rate of total ischemia time and FMCTB time between the baseline data,and analyze the reasons leading to the substandard data.The main time points of STEMI patients after onset were recorded,including:(1)STFMC time,(2)FMCTB time(including FMCTD time,FMCTECG time,DTB time,informed consent time,PTB time,catheter room activation time).(3)the total ischemia time(TIT).The compliance rate of each time node was calculated,and the current status of delay in the operation of the chest pain center in our hospital was analyzed.Compare each time node using nonparametric test whether there is any differences in three groups of different way to hospital,by the Bonferroni correction method compared between two groups,analysis of three groups of hospital way delayed specific point in time,so as to explore suitable the STEMI patients admitted to hospital best way,in order to improve our hospital and provide scientific evidence for STEMI patients rescue success rate in this area.Result:Through our line PPCI STEMI patients clinical data analysis,where different distances from the PPCI hospital,the hospital on the way to choose,to live in urban areas compared with patients with county choose to admissions,is more,the county patients mainly through the outer court into the way to the hospital,which compare the difference was statistically significant(P < 0.05),more comparison between groups there was no significant differences in choosing hospital way;Gender,place of residence significantly affect the TIT time of patients.Male patients with a smoking history and living in urban areas are more likely to complete recanalization of infarct coronary arteries within 6 hours after onset than rural patients;There was no significant correlation between FMCTB time compliance and gender,age,past medical history,admission to hospital on weekdays,place of residence,vascular type of crime,number of infarct vessels and ejection fraction.Through the comparative analysis of each time node among the three groups of admission modes,STFMC time,signature time and PTB time showed no significant difference among the three groups.FMCTB time,FMCTECG time,catheter room activation time,DTB time and TIT time were significantly different among the three groups(P < 0.05): FMCTB time of patients in the self-admission group was significantly lower than that in the out-hospital transfer group and the "120" admission group(P < 0.05);Comparison of FMCTECG time among three groups: self-admission group < out-hospital transfer group < call "120" group(P < 0.05);The activation time of catheter room in the "120" group was significantly lower than that in the transferred group(P < 0.05);The DTB time of the "120" group was significantly lower than that of the self-admission group(P < 0.05);The transferred group was significantly longer than the self-admission group and the "120" group(P < 0.05).Comparison of FMCTD time between the hospital transfer group and the "120" call group: the "120" call group was significantly lower than the hospital transfer group(P < 0.05).The compliance rate of each time node was compared among the three groups of admission methods,and significant differences were found in the compliance rate of FMCTB time,FMCTECG time and DTB time among the three groups: In this study,the FMCTB time compliance rate of our hospital was only 35.2%,and the DTB time compliance rate was 63.7%.To improve the treatment capacity of STEMI patients in this region,a lot of work still needs to do.Conclusion:1.Men and urban residents can recanalize the infarcted coronary artery within 6 hours.2.FMCTB time compliance rate in our hospital is low.The main reasons are related to the long stay and transfer time of transferred patients in non-pci hospitals outside the hospital,the imperfect operation of in-hospital green channels,and the lack of effective connection between out-of-hospital emergency treatment and in-hospital green channels.3."120" has a low call rate.4.Calling "120" shows time advantage over other two groups in TIT time and DTB time.