[Impact of establishing regional collaborative network on reperfusion time and prognosis of patients with ST-segment elevated myocardial infarction admitting to community hospitals without percutaneous coronary intervention capacity].
OBJECTIVE
To investigate the impact of establishing regional collaborative network on reperfusion time and prognosis of patients with ST-segment elevated myocardial infarction (STEMI) admitting to community hospitals without percutaneous coronary intervention (PCI) capacity (Non-PCI hospital).


METHODS
A regional collaborative network was developed, consisting of a PCI center and over 30 Non-PCI hospitals and connected by a tele-transmitted real-time 12-lead electrocardiogram system. This system enables the cardiologists on duty in PCI center to help the physicians in the Non-PCI hospitals (network hospital) to confirm the diagnosis and choose a reperfusion strategy for STEMI patients. All cardiologists in PCI center and physicians in Non-PCI hospitals were trained to follow the flowchart of reperfusion strategies for STEMI patients to shorten the reperfusion time. The mean time from door of Non-PCI hospital to needle of thrombolysis (D-to-N), the mean time from door of PCI center to balloon (D-to-B) and the mean time from the first medical contact to balloon (FMC-to-B) and the 1-year mortality were compared between the 20 months before and the 20 months after establishment of the regional collaborative network for patients with the first medical contact in three network hospitals.


RESULTS
After establishment of the regional collaborative network, the mean D-to-N time was significantly shortened from (71 ± 62) min to (28 ± 9) min (P < 0.05), the rate of D-to-N below 30 min was increased from 11% (2/18) to 74% (26/35); the mean FMC-to-B and the mean D-to-B time were remarkably reduced in both complementary percutaneous coronary intervention and transfer percutaneous coronary intervention patients (all P < 0.05), the 1-year mortality post reperfusion was reduced from 15.1% (8/53) to 7.0% (10/142) (P < 0.05).


CONCLUSIONS
The establishment of regional collaborative network could shorten the perfusion time and reduce the 1-year mortality for STEMI patients presenting to Non-PCI hospitals.
Department of Cardiology, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou 510010, China.
Tianbing
T
Duan
Email: dcxiang@foxmail.com.
Dingcheng
D
Xiang
Weiyi
W
Qin
Ying
Y
Peng
Rucheng
R
Li
Hua
H
Peng
Jinxia
J
Zhang
Yunjun
Y
Ruan
D015906:Angioplasty, Balloon, Coronary; D004562:Electrocardiography; D006760:Hospitalization; D006764:Hospitals, Community; D006801:Humans; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D015425:Myocardial Reperfusion; D010360:Patient Transfer; D062645:Percutaneous Coronary Intervention; D011379:Prognosis; D013997:Time Factors