Research Of Indices Of Reperfusion After Primary Percutaneous Coronary Intervention In Patients With Acute ST-Segment Elevation Myocardial Infarction By Different Approaches To Hospital

OBJECTIVE To compare the indices of reperfusion after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction by different approaches to hospital,and to explore the measures to optimize the diagnosis and treatment mode of existing chest pain center.METHODS Acute ST-segment elevation myocardial infarction patients undergone primary percutaneous coronary intervention were chosen from the Shanghai Chest Hospital from Jan.2016 to Dec.2018.The patients were divided,according to approaches to hospital,into routine emergency group who went to hospital by themselves(routine group,n=60),120 call-off group(120 group,n=85),referral group of non-PCI hospital(referral group,n=49).The symptom-to-balloon time,symptom-to-first medical contact time,first medical contact-to-balloon time,standard-reaching rate of first medical contact-to-balloon time,door-to-balloon time,standard-reaching rate of door-to-balloon time,first medical contact-to-electrocardiogram time,getting informed consent time,rate of prehospital ECG examination,rate of ECG remote transmission,rate of emergency bypass,hospitalization costs and the time of hospital stay were observed in 3 groups.RESULTS The average time of door-to-balloon was 72.18 minutes in all 194 cases,all three groups were below the 90-minute standard,and standard-reaching rate of door-to-balloon time of all three groups are higher than 75%,120 group is the shortest time(66.89 mins),the differece of door-to-balloon between 120 group and routine group were statistically significant(P < 0.05).The symptom-to-balloon time,first medical contact-to-balloon time,standard-reaching rate of first medical contact-to-balloon time,first medical contact-to-electrocardiogram time in referral group were significantly more than those in the other two groups(P<0.05).There was no difference in symptom-to-first medical contact time and getting informed consent time among the three groups(P>0.05).There was no difference in the rate of prehospital ECG examination,rate of ECG remote transmission and rate of emergency bypass among the three groups(P>0.05).THE CAUSES Through the construction of chest pain center,the ability and efficiency of diagnosis and treatment in the hospital were improved.But there are still pre-hospital delays.D2 B time and other indicators are up to standard.There are obvious delays in diagnosis and treatment which need improvement especially in non-PCI hospitals.