Objective To analyze the standard-reaching rate of time of door-to-balloon (D-to-B) and influencing factors in patients with acute ST-segment elevation myocardial infarction (STEMI) in different approaches to hospital.Methods STEMI patients undergone emergency PCI were chosen from the Department of Cardiology of Central Hospital of Jiading District in Shanghai from Jul. 2012 to Jun. 2016. The patients were divided, according to approaches to hospital and entering catheter room, into routine emergency group (routine group,n=120), 120 call-off group (120 group,n=54), group of pre-hospital startup through referral (referral group, n=26) and group of pre-hospital startup by WeChat platform of chest pain center (WeChat group,n=20). The duration from door to catheter room, D-to-B time, standard-reaching rate of D-to-B time and patient's decision time were observed in 4 groups, and causes of below-standard D-to-B time were analyzed.Results The standard-reaching rate of D-to-B time was 63.18% in all 220 patients, and duration from door to catheter room and D-to-B time were shorter in referral group and WeChat group than those in routine group and 120 group (P<0.01). The standard-reaching rate of D-to-B time was higher in referral group and WeChat group than that in routine group and 120 group (P<0.01). The patient's decision time was lower in referral group and WeChat group than that in routine group and 120 group (P<0.01), and also lower in routine group than that in 120 group (P<0.01). The causes of below-standard D-to-B time mainly included delayed ECG time, delayed consultation time of interventional group, delayed patient's decision time, delayed catheter room preparation time and delayed transfer time, and among them the most common cause was delayed patient's decision time. The causes of below-standard D-to-B time were anatomic variation or operational difficulties during operation in referral group and WeChat group. Conclusion D-to-B time can be shortened and standard-reaching rate of D-to-B time can be improved through implementing pre-hospital startup after setting up WeChat platform of chest pain center.%目的 本研究旨在分析不同就诊途径的急性ST段抬高型心肌梗死(STEMI)患者行急诊经皮冠状动脉介入治疗(PCI)门-球(D-to-B)时间的达标情况和影响因素.方法 入选自2012年7月~2016年6月于上海市嘉定区中心医院心内科行急诊PCI的STEMI患者,根据就诊及进入导管室的途径分为:常规急诊就诊组(120例)、呼叫120来院组(54例)、转诊来院院前启动组(26例)、胸痛中心微信平台院前启动组(20例).观察4组进门至导管室时间、D-to-B时间、D-to-B时间达标率和患者决定时间并分析D-to-B时间不达标的原因.结果 所有220例患者总的D-to-B时间达标率为63.18%,其中转诊来院院前启动组和胸痛中心微信平台院前启动组进门至导管室时间和D-to-B时间短于常规急诊就诊组和呼叫120来院组,差异有统计学意义(P<0.01).转诊来院院前启动组和胸痛中心微信平台院前启动组D-to-B时间达标率均高于常规急诊就诊组和呼叫120来院组,差异有统计学意义(P<0.01).比较患者决定时间,转诊来院院前启动组和胸痛中心微信平台院前启动组均低于常规急诊就诊组和呼叫120来院组,差异有统计学意义(P<0.01).常规急诊就诊组也低于呼叫120来院组,差异有统计学意义(P<0.01).常规急诊就诊组和呼叫120来院就诊组D-to-B时间不达标的原因主要包括心电图时间延迟、介入组会诊时间延迟、患者决定时间延迟、导管室准备及转运时间延迟以及术中延迟,其中患者决定时间延迟例数最多.转诊来院院前启动组和胸痛中心微信平台院前启动组D-to-B时间不达标原因是手术过程中解剖变异或操作困难引起.结论 建立胸痛中心,通过微信平台实现院前启动可以明显缩短D-to-B时间,提高D-to-B时间达标率.
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