[Feasibility and efficacy of the regional cooperative ST-segment elevation myocardial infarction rescue network among the prefectural-level city hospitals]

Zhonghua Xin Xue Guan Bing Za Zhi. 2017 Aug 24;45(8):706-709. doi: 10.3760/cma.j.issn.0253-3758.2017.08.017.
[Article in Chinese]

Abstract

Objective: To investigate the feasibility and efficacy of the establishment of regional cooperative acute ST-segment elevation myocardial infarction (STEMI) rescue network among the prefectural-level city hospitals in China. Methods: Based on real-time remote electrocardiogram transmission and "120" emergency systems, we established a regional collaborative STEMI treatment network with our hospital as the network unclears including 8 second-class affiliated hospitals of Jiangsu University in 2013. STEMI treatment time, therapeutic effects and economic indexes were compared before (from January 2010 to December 2012, 180 cases, pre-network) and after (From January 2013 to December 2015, 374 cases, post-network) the establishment of the regional collaborative STEMI treatment network. Results: Post establishment of the rescue network, mean first medical contact (FMC) to balloon (FMC-to-B) time, referral time and obtaining informed consent time were all significantly decreased from (191±41), (94±18), (25±9) minutes to (93±19), (53±18), (7±5) minutes, respectively, in comparison with the pre-network era(all P<0.05). There was a trend of prolonged FMC-to-B time in proportion to aging of STEMI patients(trend P<0.05). Three months post discharge, LVEF was higher (55.3%±10.7% vs. 48.8%±12.1%, P<0.05) and LVEDd was lower ((49.1±10.8)mm vs.(51.8±9.2)mm, P<0.05) in the post-network group compared to pre-network group.In-hospital mortality was also significantly reduced post the establishment of the rescue network (2.14%(8/374) vs. 3.89%(7/180), P<0.05). The results also showed that the total costs (42 017(25 069, 75 148)yuan vs.51 030(28 137, 105 861)yuan), days of hospitalization ((9.1±4.5) days vs. (15.3±4.8)days) and percentage of medicine and consumables were all significantly decreased in the post-network group compared to pre-network group(all P<0.05). Conclusion: Establishment of the regional cooperative rescue network is feasible among the prefectural-level city hospitals in China. Establishment of such network can improve the prognosis and decrease the FMC-to-B time, the rate of in-hospital mortality and financial burden of patients with STEMI, and serves as an effective strategy to improve the rescue ability for STEMI patients.

目的: 探讨在我国地市级医院建立区域化协同救治急性ST段抬高型心肌梗死(STEMI)的可行性及实施效果。 方法: 以实时心电图远程传输系统为核心,"120"急救为纽带,以地市级镇江地区为中心,建立江苏大学附属医院所辖的8个二级医院区域化协同救治STEMI网络,总结区域化协同救治网络建立前(2010年1月至2012年12月,180例)及建立后(2013年1月至2015年12月,374例)STEMI救治时间节点、治疗效果及经济学指标进行比较。 结果: 区域化协同救治网络实施后STEMI患者首次医疗接触到球囊扩张(FMC-to-B)时间、转诊时间及获得知情同意时间[分别为(93±19)、(53±18)、(7±5)min]均短于实施前[分别为(191±41)、(94±18)、(25±9)min,P均<0.05],实施前、后的FMC-to-B时间随年龄增大有延长的趋势(趋势检验P均<0.05);实施后患者心功能较实施前明显改善[左心室射血分数:(55.3±10.7)%比(48.8±12.1)%,左心室舒张末期内径:(49.1±10.8)mm比(51.8±9.2)mm;P均<0.05],住院期间病死率低于实施前[2.14%(8/374)比3.89%(7/180),P<0.05]。实施后患者平均住院时间[(9.1±4.5)d比(15.3±4.8)d]、住院费用[42 017(25 069,75 148)元比51 030(28 137, 105 861)元]、医疗收入中耗材占用比例(42.7%比49.6%)及药品占用比例(9.1%比12.3%)均低于实施前(P均<0.05)。 结论: 地市级医院实施区域化协同救治STEMI网络可行性强,可明显缩短患者FMC-to-B时间,改善预后,减轻患者经济负担,是提升STEMI救治能力的有效方法。.

Keywords: Emergency medical services; Myocardial infarction.

MeSH terms

  • China
  • Community Networks*
  • Electrocardiography
  • Hospitals, Urban*
  • Humans
  • Myocardial Infarction
  • Percutaneous Coronary Intervention*
  • ST Elevation Myocardial Infarction*
  • Time Factors