In-hospital Major Adverse Cardiovascular Events After Percutaneous Coronary Intervention In Patients With Acute ST-segment Elevation Myocardial Infarction: A Retrospective Study Under The China Chest Pain Center(Standard Center) Treatment System

Background: Cardiovascular prevalence in China is on a continuous increase,of which acute ST-segment elevation myocardial infarction(STEMI)is a time-sensitive emergency and is associated with high morbidity and mortality that requires urgent and well-coordinated care by the healthcare system.The China chest pain center is a multidisciplinary collaborative program designed to promote better evaluation of patients with symptoms of chest pain,thereby enhancing early diagnosis and treatment,reducing misdiagnosis,underdiagnosis and overtreatment,and improving the clinical prognosis of patients with chest pain.China chest pain center certification is associated with improved inpatient clinical outcomes and better management of acute STEMI patients,including shorter treatment delays,more widespread use of PCI,and lower inhospital mortality.Under this system,acute STEMI patients receive timely treatment with percutaneous coronary intervention(PCI)but remain at high risk for major adverse cardiovascular events(MACE).Objective: This study aimed to investigate the independent risk factors and their predictive value of in-hospital MACE after primary PCI in patients with acute STEMI under the China chest pain center(standard center)treatment system.Methods: A single-center,retrospective study of 151 patients with acute STEMI undergoing primary PCI was performed.All patients were treated under the China chest pain center(standard center)treatment system.The data collected included general data,vital signs,auxiliary examination results,data related to interventional therapy,and various treatment delays.The primary endpoint was the in-hospital MACE defined as the composite of all-cause death,stroke,nonfatal recurrent myocardial infarction,newonset heart failure,and malignant arrhythmias.Patients were divided into MACE and non-MACE groups according to whether in-hospital MACE occurred,and the aforementioned data were statistically analyzed.Results: In-hospital MACE occurred in 71 of 151 patients with acute STEMI undergoing primary PCI.The patients who experienced in-hospital MACE presented with higher age,cardiac troponin I(c Tn I),serum creatinine(s Cr),and proportions of Killip class III/IV and multivessel coronary artery disease but lower levels of systolic blood pressure(SBP),diastolic blood pressure(DBP),estimated glomerular filtration rate(e GFR),and left ventricular ejection fraction(LVEF),while the difference in treatment delays between the groups was not statistically significant.Univariate logistic regression analysis showed that age,s Cr,multivessel coronary artery disease,c Tn I,and Killip class III/IV were risk factors for in-hospital MACE in patients with acute STEMI undergoing PCI,while e GFR,LVEF,systolic blood pressure,and diastolic blood pressure were protective factors.Multivariate logistic regression showed that e GFR,LVEF,c Tn I,systolic blood pressure,and Killip class III/IV were independent risk factors for in-hospital MACE in patients with acute STEMI undergoing PCI.The prediction model had good discrimination with an area under the curve = 0.778(0.690–0.865).Good calibration and clinical utility were observed through the calibration and decision curves,respectively.Conclusions: Under the China chest pain center(standard center)treatment system,e GFR,LVEF,c Tn I,systolic blood pressure,and Killip class III/IV independently predict in-hospital MACE after primary PCI in patients with acute STEMI,and the prediction model constructed based on the above factors could be useful for individual risk assessment and early management guidance.