Impact of chest pain center quality control indicators on mortality risk in ST-segment elevation myocardial
Lingling Zhang1,2,3, Jianping Zeng1,2,4, Haobo Huang1,2
1Department of Cardiology, Xiangtan Central Hospital, Xiangtan, China.
Insights
Chest pain center quality indicators impact ST-segment elevation myocardial infarction (STEMI) mortality, varying by patient severity. Optimizing time metrics in chest pain centers (CPCs) is crucial for reducing STEMI deaths, especially during the COVID-19 pandemic.
Area of Science:
- Cardiology
- Public Health
- Healthcare Management
Background:
- ST-segment elevation myocardial infarction (STEMI) mortality remains high in China despite Chest Pain Center (CPC) initiatives.
- Primary percutaneous coronary intervention (PPCI) is a key treatment for STEMI.
- The COVID-19 pandemic introduced challenges to acute cardiac care management.
Purpose of the Study:
- To evaluate the impact of CPC quality control indicators on STEMI patient mortality.
- To assess how these indicators influence outcomes in patients undergoing PPCI during the COVID-19 pandemic.
- To identify specific time-related metrics critical for improving STEMI survival rates.
Main Methods:
- A cohort of 664 STEMI patients undergoing PPCI from 2020-2022 was analyzed.
- Cox proportional hazards regression models were used to assess mortality risk.
- Patients were stratified by Killip classification (Class 1 vs. Class ≥2) at admission.
Main Results:
- 35 deaths occurred during a median 17-month follow-up.
- In Killip Class ≥2 patients, longer door-to-balloon time, PCI informed consent time, lab activation time, and DAPT time were linked to higher mortality.
- In Killip Class 1 patients, consultation time <10 min reduced mortality risk; in Class ≥2, PCI informed consent time <20 min decreased mortality.
Conclusions:
- CPC quality control indicators significantly influence STEMI mortality, with effects stratified by Killip class.
- Time-sensitive metrics, such as door-to-balloon and informed consent times, are critical for improving outcomes.
- Standardizing CPC management and focusing on key time indicators can enhance STEMI care, particularly during public health crises like COVID-19.
Background:
Despite the crucial role of Chest pain centers (CPCs) in acute myocardial infarction (AMI) management, China's mortality rate for ST-segment elevation myocardial infarction (STEMI) has remained stagnant. This study evaluates the influence of CPC quality control indicators on mortality risk in STEMI patients receiving primary percutaneous coronary intervention (PPCI) during the COVID-19 pandemic.
Methods:
A cohort of 664 consecutive STEMI patients undergoing PPCI from 2020 to 2022 was analyzed using Cox proportional hazards regression models. The cohort was stratified by Killip classification at admission (Class 1: n = 402, Class ≥2: n = 262).
Results:
At a median follow-up of 17 months, 35 deaths were recorded. In Class ≥2, longer door-to-balloon (D-to-B) time, PCI informed consent time, catheterization laboratory activation time, and diagnosis-to-loading dose dual antiplatelet therapy (DAPT) time were associated with increased mortality risk. In Class 1, consultation time (notice to arrival) under 10 min reduced death risk. In Class ≥2, PCI informed consent time under 20 min decreased mortality risk.
Conclusion:
CPC quality control metrics affect STEMI mortality based on Killip class. Key factors include time indicators and standardization of CPC management. The study provides guidance for quality care during COVID-19.
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