The impacts of the chest pain center accreditation on the efficacy of pre-hospital care in patients with ST-segment elevation myocardial infarction

目的 探讨中国胸痛中心认证对行直接经皮冠状动脉介入治疗(primary percutaneous coronary intervention,PPCI)的ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者院前救治效率的影响.方法 回顾性分析中国胸痛中心认证云平台数据库,以全国已通过认证的前8批医院为研究对象,对平均每月PPCI例数、平均入门至球囊扩张(door-to-ballon,D2B)时间等数据进行分析,分别比较通过认证前的6个月以及认证后的12个月的变化趋势.结果 共68家通过认证的医院纳入本研究.在通过认证后,平均每月D2B时间为(79.9±23.9)分钟,明显短于认证前[(95.1±33.2)分钟](P<0.05);平均每月院前心电图远程传输比率为47.4%,平均每月经120接诊及网络医院转入的患者绕行急诊和冠心病监护病房(cardiac care unit,CCU)直达导管室的比率为34.6%,均显著高于认证前(38.4%,25.6%)(P<0.05);首次医疗接触至完成首份心电图的时间认证前后比较无显著差异,但均达到了认证标准;通过认证后平均每月收治的PPCI患者例数与认证前比较无显著差异,但有增加的趋势.结论 胸痛中心认证所推动的胸痛中心规范化建设显著提高了院前急救和院内救治的效率,缩短了救治时间,使更多的STEMI患者能够在指南推荐的时间内完成医疗接触后的早期诊疗工作.Objective This study intends to explore the impacts of chest pain center accreditation on the efficacy of pre-hospital care in patients with ST-segment elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PPCI). Method Data in this study were originated from the cloud platform database of Chinese chest pain center. Patients from chest pain centers which had passed the accreditation in the last two years enrolled in this study. The monthly average of PPCI, the monthly average door-to-ballon (D2B) time, the monthly average first medical contact to electrocardiogram (FMC2ECG) time, the percentage of remote transmitting ECG and the percentage of bypass the emergency department and cardiac care unit (CCU) were compared before and after the accreditation of chest pain center. Result Patients from 68 chest pain centers were enrolled in this study. The average D2B time after the accreditation of chest pain center [(79.9±23.9) min] was significantly shortened than before the accreditation of chest paincenter [(95.1±33.2) min] (P < 0.05). The percentage of remote transmitting ECG (47.4%) and the percentage of bypass the emergency department and CCU (34.6%) was remarkable higher than before the accreditation of chest pain center (38.4%, 25.6% ) (P < 0.05). There were no statistical differences in the FMC2ECG, but they all complied with the chest pain center accreditation whether before or after the accreditation. The monthly average of PPCI showed a trend of incline without a statistically significant (P > 0.05). Conclusion The establishment and accreditation of chest pain center may significantly improve the efficiency of pre-hospital care in patients with STEMI who underwent PPCI.国家科技部重点研发计划专项; 广东省医疗物联网推广应用工程; 广州市重点实验室建设专项; 广州市科技计划重大专项111-15