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The data input process for most chest pain centers is not intelligent, requiring a lot of staff to manually input patient information. This leads to problems such as long processing times, high potential for errors, an inability to access patient data in a timely manner and an increasing workload. To address the challenge, an Internet of Things (IoT)-driven chest pain center is designed, which crosses the sensing layer, network layer and application layer. The system enables the construction of intelligent chest pain management through a pre-hospital app, Ultra-Wideband (UWB) positioning, and in-hospital treatment. The pre-hospital app is provided to emergency medical services (EMS) centers, which allows them to record patient information in advance and keep it synchronized with the hospital's database, reducing the time needed for treatment. UWB positioning obtains the patient's hospital information through the zero-dimensional base station and the corresponding calculation engine, and in-hospital treatment involves automatic acquisition of patient information through web and mobile applications. The system also introduces the Bidirectional Long Short-Term Memory (BiLSTM)-Conditional Random Field (CRF)-based algorithm to train electronic medical record information for chest pain patients, extracting the patient's chest pain clinical symptoms. The resulting data are saved in the chest pain patient database and uploaded to the national chest pain center. The system has been used in Liaoning Provincial People's Hospital, and its subsequent assistance to doctors and nurses in collaborative treatment, data feedback and analysis is of great significance.

BackgroundDespite 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.MethodsA 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).ResultsAt 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.ConclusionCPC 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.

BACKGROUND: Myocardial infarction (MI) is a series of clinical syndromes caused by ischemic necrosis of myocardial cells that results from severe and persistent acute ischemia of the myocardium due to a dramatic reduction or interruption of coronary blood supply. OBJECTIVE: In this study, we analyzed the role of pre-hospital emergency services in the rescue of patients suffering from ST-elevation myocardial infarction (STEMI). METHODS: We enrolled 229 patients with STEMI who were transported to the Second Hospital of Tianjin Medical University by Tianjin Emergency Center from January 2017 to June 2021. With the development of the pre-hospital emergency medical system in Tianjin (2019) as the time node, the patients were divided into three groups: A (87 cases), B (68 cases), and C (74 cases). The onset-to-call time, emergency response time, door-to-balloon (D-B) time, first medical contact to balloon dilation (FMC-B) time, symptom onset-to-balloon dilation (S-B) time, proportion of patients receiving prehospital administration of bispecific antibodies, number of days hospitalized, total hospitalization expenses, and in-hospital incidence and mortality of heart failure were compared between the three groups. RESULTS: Group C differed significantly from group A and group B in terms of emergency response time, D-B time, FMC-B time, S-B time, the proportion of patients who received prehospital administration of bispecific antibodies, and the number of days of hospitalization (P < 0.05), but there was no significant difference in the onset-to-call time (P > 0.05) and the decreasing trends in the in-hospital incidence and mortality of heart failure were not statistically significant (incidence: 9.50% vs. 13.23%, 12.64%; mortality: 4.10% vs. 5.90%, 4.60%). CONCLUSION: A reasonable pre-hospital emergency medical network layout and resource investment, as well as the strengthening of the interface between pre-hospital and in-hospital medical emergencies and pre-hospital standardized rescue, can shorten the emergency response time and the total ischemic time in patients with chest pain, which can improve patient prognosis to a certain extent. [ABSTRACT FROM AUTHOR]

Objective To construct an early diagnosis model of acute pulmonary thromboembolism (PTE) based on chest pain center database. Methods According to the database of Chest Pain Center of Affiliated Hospital of Jining Medical University, the clinical data of patients who visited the emergency department from January to December 2020 were retrospectively collected, and the patients were divided into PTE group and non-PTE chest pain group according to whether diagnosed PTE. The clinically relevant indicators of the two groups were compared, and the study indicators with statistical differences between the two groups were included in the multivariate logistic regression analysis, and a nomogram model for the early diagnosis of PTE was established. The receiver operating characteristic (ROC) curve of the model was plotted to assess the predictive accuracy, and the model was tested for goodness of fit using the Hosmer-Lemeshow test. An additional 654 patients presenting with chest pain between January 2021 and March 2021 were collected to externally validate the model. Results A total of 2 738 patients were included for the construction of the model, of whom 117 (4.27%) had confirmed PTE. On multivariate analysis, a history of surgical trauma, ＞ 3 d of immobilization / bed rest on the lower extremities, with dyspnea, syncope, low pulse oxygen staturation (SpO2) at admission, high D-dimer, right deviation of electrocardiographic axis, and complete right bundle branch block were independent factors for the diagnosis of PTE in patients with chest pain (P＜0.05) . ROC curve analysis showed that the area under the curve was 0.985 (95%CI: 0.969-0.999) in internal validation data and 0.924 (95%CI: 0.872-0.977) in external validation data, showing that the model had a good discrimination. The goodness of fit test was performed using Hosmer-Lemeshow, and validated internally (χ2=14.077, P=0.080) and external validation (χ2=615.690, P=0.986) both indicating a good fit of the model. Conclusion This study constructed a nomogram model for the diagnosis of PTE in patients with acute chest pain, and this model could effectively predict the risk probability of PTE in patients with acute chest pain.

Abstract Background Patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) are at high risk of major adverse cardiovascular events (MACE) despite timely treatment. This study aimed to investigate the independent predictors and their predictive value of in-hospital MACE after primary PCI in patients with acute STEMI under the China chest pain center (standard center) treatment system. Methods We performed a single-center, retrospective study of 151 patients with acute STEMI undergoing primary PCI. All patients were treated under the China chest pain center (standard center) treatment system. The data collected included general data, vital signs, auxiliary examination results, data related to interventional therapy, and various treatment delays. The primary endpoint was the in-hospital MACE defined as the composite of all-cause death, stroke, nonfatal recurrent myocardial infarction, new-onset heart failure, and malignant arrhythmias. Results In-hospital MACE occurred in 71 of 151 patients with acute STEMI undergoing primary PCI. Logistic regression analysis showed that age, cardiac troponin I (cTnI), serum creatinine (sCr), multivessel coronary artery disease, and Killip class III/IV were risk factors for in-hospital MACE, whereas estimated glomerular filtration rate (eGFR), left ventricular ejection fraction (LVEF), systolic blood pressure (SBP), diastolic blood pressure (DBP), were protective factors, with eGFR, LVEF, cTnI, SBP, and Killip class III/IV being independent predictors of in-hospital MACE. The prediction model had good discrimination with an area under the curve = 0. 778 (95%CI: 0.690–0.865). Good calibration and clinical utility were observed through the calibration and decision curves, respectively. Conclusions Our data suggest that eGFR, LVEF, cTnI, SBP, and Killip class III/IV independently predict in-hospital MACE after primary PCI in patients with acute STEMI, and the prediction model constructed based on the above factors could be useful for individual risk assessment and early management guidance.

Our object was to examine how the pre- and post-pandemic COVID-19 impacted the care of acute ST-segment elevation myocardial infarction (STEMI) patients in county hospitals. Using January 20, 2020, as the time point for the control of a unique coronavirus pneumonia epidemic in Jieshou, 272 acute STEMI patients were separated into pre-epidemic (group A, n = 130) and epidemic (group B, n = 142). There were no significant differences between the two groups in terms of mode of arrival, symptom onset-to-first medical contact time, door-to-needle time, door-to-balloon time, maximum hypersensitive cardiac troponin I levels, and in-hospital adverse events (P > 0.05). Emergency percutaneous coronary intervention (PCI) was much less common in group B (57.7%) compared to group A (72.3%) (P = 0.012), and the proportion of reperfusion treatment with thrombolysis was 30.3% in group B compared to 13.1% in group A (P < 0.001). Logistic regression analysis showed that age ≥76 years, admission NT-proBNP levels ≥3,018 pg/ml, and combined cardiogenic shock were independent risk factors for death. Compared with thrombolytic therapy, emergency PCI treatment further reduced the risk of death in STEMI. In conclusion, the county hospitals treated more acute STEMI with thrombolysis during the COVID-19 outbreak.

Abstract Background The introduction of chest pain centers (CPC) in China has achieved great success in shortening the duration of nursing operations to significantly improve the treatment and outcomes of patients with ST-segment elevation myocardial infarction (STEMI). The nursing handover period is still considered the high incidence period of adverse events because of the distractibility of nurses’ attention, potential interruption, and unclear responsibilities. Under the CPC mechanism, the nursing efficiency and patients’ outcome, whether affected by the nursing handover, is still a knowledge gap in research. This is also the aim of this study. Methods A retrospective study was conducted with data from STEMI patients from a tertiary hospital in the north of Sichuan Province from January 2018 to December 2019 through the Chinese CPC database. Patients are divided into handover and non-handover groups according to the time they presented in the Emergency Department. D2FMC, FMC2FE, FMC2BS, FMC2CBR, FMC2FAD, and D2W were selected to measure nursing efficiency. The occurrence of major adverse cardiovascular events, the highest troponin values within 72 h of hospitalization, and the length of hospitalization were selected to measure the patient outcomes. Continuous variables are summarized as mean ± SD, and t-tests of the data were performed. P-values

Background: Patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) are at high risk of major adverse cardiovascular events (MACE) despite timely treatment. This study aimed to investigate the independent predictors and their predictive value of in-hospital MACE after primary PCI in patients with acute STEMI under the China chest pain center (standard center) treatment system. Methods: We performed a single-center, retrospective study of 151 patients with acute STEMI undergoing primary PCI. All patients were treated under the China chest pain center (standard center) treatment system. The data collected included general data, vital signs, auxiliary examination results, data related to interventional therapy, and various treatment delays. The primary endpoint was the in-hospital MACE defined as the composite of all-cause death, stroke, nonfatal recurrent myocardial infarction, new-onset heart failure, and malignant arrhythmias. Results: In-hospital MACE occurred in 71 of 151 patients with acute STEMI undergoing primary PCI. Logistic regression analysis showed that age, cardiac troponin I (cTnI), serum creatinine (sCr), multivessel coronary artery disease, and Killip class III/IV were risk factors for in-hospital MACE, whereas estimated glomerular filtration rate (eGFR), left ventricular ejection fraction (LVEF), systolic blood pressure (SBP), diastolic blood pressure (DBP), were protective factors, with eGFR, LVEF, cTnI, SBP, and Killip class III/IV being independent predictors of in-hospital MACE. The prediction model had good discrimination with an area under the curve = 0. 778 (95%CI: 0.690–0.865). Good calibration and clinical utility were observed through the calibration and decision curves, respectively. Conclusions: Our data suggest that eGFR, LVEF, cTnI, SBP, and Killip class III/IV independently predict in-hospital MACE after primary PCI in patients with acute STEMI, and the prediction model constructed based on the above factors could be useful for individual risk assessment and early management guidance. [ABSTRACT FROM AUTHOR]

Background Chest pain center (CPC) accreditation plays an important role in the management of acute myocardial infarction (AMI). However, no evidence shows whether the outcomes of AMI patients are improved with CPC accreditation in China. Methods and Results This retrospective analysis is based on a predesigned nationwide registry, CCC-ACS (Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome). The primary outcome was major adverse cardiovascular events (MACE), including all-cause death, reinfarction, stent thrombosis, stroke, and heart failure. A total of 15 344 AMI patients, from 40 CPC-accredited hospitals, were enrolled, including 7544 admitted before and 7800 after accreditation. In propensity score matching, 6700 patients in each group were matched. The incidence of 7-day MACE (6.7% versus 8.0%; P=0.003) and all-cause death (1.1% versus 1.6%; P=0.021) was lower after accreditation. In multivariate adjusted mixed-effects Cox proportional hazards models, CPC accreditation was associated with significantly decreased risk of MACE (hazard ratio: 0.78; 95% CI, 0.68-0.91) and all-cause death (hazard ratio: 0.71; 95% CI, 0.51-0.99). The risk of MACE and all-cause death both followed a reverse J-shaped trend: the risk of MACE and all-cause death decreased gradually after achieving CPC accreditation, with minimal risk occurring in the first year, but increased in the second year and after. Conclusions Based on a large-scale national registry data set, CPC accreditation was associated with better in-hospital outcomes for AMI patients. However, the benefits seemed to attenuate over time, and reaccreditation may be essential for maintaining AMI care quality and outcomes.

Background: The introduction of chest pain centers (CPC) in China has achieved great success in shortening the duration of nursing operations to significantly improve the treatment and outcomes of patients with ST-segment elevation myocardial infarction (STEMI). The nursing handover period is still considered the high incidence period of adverse events because of the distractibility of nurses' attention, potential interruption, and unclear responsibilities. Under the CPC mechanism, the nursing efficiency and patients' outcome, whether affected by the nursing handover, is still a knowledge gap in research. This is also the aim of this study. Methods: A retrospective study was conducted with data from STEMI patients from a tertiary hospital in the north of Sichuan Province from January 2018 to December 2019 through the Chinese CPC database. Patients are divided into handover and non-handover groups according to the time they presented in the Emergency Department. D2FMC, FMC2FE, FMC2BS, FMC2CBR, FMC2FAD, and D2W were selected to measure nursing efficiency. The occurrence of major adverse cardiovascular events, the highest troponin values within 72 h of hospitalization, and the length of hospitalization were selected to measure the patient outcomes. Continuous variables are summarized as mean ± SD, and t-tests of the data were performed. P-values < 0.05 (two-tailed) were considered statistically significant. Results: A total of 231 cases were enrolled, of which 40 patients (17.3%) were divided into the handover period group, and 191 (82.6%) belonged to the non-handover period group. The results showed that the handover period group took significantly longer on items FMC2BS (P < 0.001) and FMC2FAD (P < 0.001). Still, there were no significant differences in D2FMC and FMC2FE, and others varied too little to be clinically meaningful, as well as the outcomes of patients. Conclusion: This study confirms that nursing handover impacts the nursing efficiency of STEMI patients, especially in FMC2BS and FMC2FAD. Hospitals should also reform the nursing handover rules after the construction of CPC and enhance the triage training of nurses to assure nursing efficiency so that CPC can play a better role. [ABSTRACT FROM AUTHOR]

Our object was to examine how the pre- and post-pandemic COVID-19 impacted the care of acute ST-segment elevation myocardial infarction (STEMI) patients in county hospitals. Using January 20, 2020, as the time point for the control of a unique coronavirus pneumonia epidemic in Jieshou, 272 acute STEMI patients were separated into preepidemic (group A, n = 130) and epidemic (group B, n = 142). There were no significant differences between the two groups in terms of mode of arrival, symptom onsetto-first medical contact time, door-to-needle time, door-toballoon time, maximum hypersensitive cardiac troponin I levels, and in-hospital adverse events (P > 0.05). Emergency percutaneous coronary intervention (PCI) was much less common in group B (57.7%) compared to group A (72.3%) (P = 0.012), and the proportion of reperfusion treatment with thrombolysis was 30.3% in group B compared to 13.1% in group A (P < 0.001). Logistic regression analysis showed that age ≥76 years, admission NT-proBNP levels ≥3,018 pg/ml, and combined cardiogenic shock were independent risk factors for death. Compared with thrombolytic therapy, emergency PCI treatment further reduced the risk of death in STEMI. In conclusion, the county hospitals treated more acute STEMI with thrombolysis during the COVID-19 outbreak. [ABSTRACT FROM AUTHOR]

This study aimed to explore the effectiveness of a multidisciplinary cooperative first aid model in the process of establishing a chest pain center specializing in acute aortic dissection (AD). A quality improvement report. A total of 142 patients with acute aortic dissection treated before and after the optimization of the chest pain center process in our hospital were included. According to their admission time: the group before the optimization process was designated as the control group (66 cases) and the group after the optimization process was the intervention group (76 cases). The control group received conventional emergency treatment, while the intervention group received treatment through a multidisciplinary cooperative first aid model. The treatment times for both groups were compared: the time from first medical contact(FMC) to completion of an electrocardiogram (ECG), the diagnosis time, and the time spent in the emergency department. The research findings revealed that the intervention group had significantly shorter times for FMC-to-ECG, diagnosis time, and emergency stay compared to the control group (P < 0.001). Our findings indicate that by optimizing the multidisciplinary cooperative first aid model and procedures, the treatment of patients has indeed been effectively ensured, achieving safety outcomes. For chest pain centers, we suggest that to use multidisciplinary cooperative first aid model to get repaid and definite diagnosis of various causes of chest pain. A bedside transthoracic echocardiography is recommended to use in order to identify AD before proceeding with further treatment. [ABSTRACT FROM AUTHOR]

Abstract Objective To study the effect of the establishment of a Chest Pain Center (CPC) on the treatment delay of ST-elevation myocardial infarction (STEMI) patients and the influencing factors of treatment delay in a large hospital in China. Methods The study subjects are 318 STEMI patients admitted between August 2016 and July 2019 to a large general hospital in Henan, China. Data were extracted from the electronic medical records after removing personal identifiable information. The interrupted time series regression was used to analyze the treatment delay of patients before and after the CPC establishment. Results After the CPC establishment, the patients’ pre-hospital and in-hospital treatment delays were significantly reduced. SO-to-FMC (Symptom Onset to First Medical Contact time) decreased by 49.237 min and D-to-B (Door to Balloon time) decreased by 21.931 min immediately after the CPC establishment. In addition, SO-to-FMC delay is significantly correlated with age, occupation, nocturnal onset, and the way to hospital. D-to-B delay is significantly associated with time from initial diagnosis to informed consent of percutaneous coronary intervention (PCI), catheterization lab activation time, and time for PCI informed consent. Conclusion The CPC significantly reduced the treatment delay of STEMI patients undergoing PCI.

Objective　To investigate the treatment strategy and prognosis of de Winter syndrome. Methods Retrospective analysis was performed on 261 patients with acute anterior wall myocardial infarction admitted in our hospital, and those with ECG changes of de Winter syndrome were selected to analyze the coronary angiographic results, treatment and prognosis. Results　Five patients (accounting for 1. 9%) with acute anterior wall myocardial infarction consistent with ECG changes of de Winter syndrome are screened out, including 4 males and one female. The culprit vessel of the 5 patients are left anterior descending branch or diagonal branch, and all successfully treated by primary percutaneous coronary intervention. They are followed up 6 months after the surgery, and one patient suffers from postoperative angina pectoris while no cardiac insufficiency or sudden cardiac death is found. Conclusion　As an equivalence of ST-segment elevation myocardial infarction in the criticality, de Winter syndrome requires for a timely and effective opening of the culprit vessels to realize a favourable prognosis. [ABSTRACT FROM AUTHOR]

ST-segment elevation myocardial infarction (STEMI) is a common cardiovascular emergency for which timely reperfusion therapies are needed to minimize myocardial necrosis. The aim of this study was to investigate the impact of the COVID-19 pandemic and reorganization of chest pain centers (CPC) on the practice of primary percutaneous coronary intervention (PPCI) and prognosis of STEMI patients. This single-center retrospective survey included all patients with STEMI admitted to our CPC from January 22, 2020 to April 30, 2020 (during COVID-19 pandemic in Wuhan), compared with those admitted during the analogous period in 2019, in respect of important time points of PPCI and clinical outcomes of STEMI patients. In the present article, we observed a descending trend in STEMI hospitalization and a longer time from symptom onset to first medical contact during the COVID-19 pandemic as compared to the control period (4.35 h versus 2.58 h). With a median delay of 17 minutes in the door to balloon time (D2B), the proportion of in-hospital cardiogenic shock was significantly higher in the COVID-19 era group (47.6% versus 19.5%), and major adverse cardiac events (MACE) tend to increase in the 6-month follow-up period (14.3% versus 2.4%). Although the reorganization of CPC may prolong the D2B time, immediate revascularization of the infarct-related artery could be offered to most patients within 90 minutes upon arrival. PPCI remained the preferred treatment for patients with STEMI during COVID-19 pandemic in the context of timely implementation and appropriate protective measures.

Objective: To study the effect of the establishment of a Chest Pain Center (CPC) on the treatment delay of ST-elevation myocardial infarction (STEMI) patients and the influencing factors of treatment delay in a large hospital in China.Methods: The study subjects are 318 STEMI patients admitted between August 2016 and July 2019 to a large general hospital in Henan, China. Data were extracted from the electronic medical records after removing personal identifiable information. The interrupted time series regression was used to analyze the treatment delay of patients before and after the CPC establishment.Results: After the CPC establishment, the patients' pre-hospital and in-hospital treatment delays were significantly reduced. SO-to-FMC (Symptom Onset to First Medical Contact time) decreased by 49.237 min and D-to-B (Door to Balloon time) decreased by 21.931 min immediately after the CPC establishment. In addition, SO-to-FMC delay is significantly correlated with age, occupation, nocturnal onset, and the way to hospital. D-to-B delay is significantly associated with time from initial diagnosis to informed consent of percutaneous coronary intervention (PCI), catheterization lab activation time, and time for PCI informed consent.Conclusion: The CPC significantly reduced the treatment delay of STEMI patients undergoing PCI. [ABSTRACT FROM AUTHOR]

Given the increasing burden of acute myocardial infarction (AMI) in China, regional cooperative rescue systems have been constructed based on chest pain centers (CPCs). This study evaluated the effects of these regional cooperative rescue systems on reperfusion time and prognosis of AMI patients. This study included 1937 AMI patients, divided into two groups according to the date of admission, group A (July 2017–June 2018) and group B (July 2018–June 2019). Reperfusion time, the fatality rate for any cause during hospitalization, and the incidence of major adverse cardiovascular and cerebrovascular events (MACCE) in the 6 months following discharge were compared between the two groups. The proportion of patients treated within the guideline goals for first medical contact to balloon (FMC-to-B) time showed improvement from 40.7% in group A to 50.4% in group B (P = 0.005). The fatality rate for any cause (5.5% vs. 8.0%, P = 0.026) during hospitalization was lower in the B group compared to the A group. Multivariate logistic regression analysis revealed that the fatality rate for any cause (OR 0.614, 95% CI 0.411–0.918, P = 0.017) was significantly lower in group B compared with group A. No significant differences were detected between the two groups for the incidence of MACCE and death for any cause at 6 months using the log-rank test and multivariate Cox regression analysis. The improvement of regional cooperative rescue systems shortened system delays and reduced in-hospital deaths. Although the system has resulted in some substantial improvements, additional improvement is needed. [ABSTRACT FROM AUTHOR]

Objective　To explore the application effect of Chest Pain Center in standardized training for cardiovascular practitioner. Methods　Fifty-two students for cardiovascular practice were selected from 2020 July to September, they were randomly divided into the two groups with 26 cases in each group. The experimental group adopted the teaching method of Micro courses, mini CEX was used in the control group. The teaching achievement and teaching satisfaction between the two groups were compared. Results　The Mini-CEX scale for interns in the experimental group were significantly higher than those when they were enrolled (P < 0.01). The results of questionnaire survey on teaching performance and teaching satisfaction rate in the experimental group were significantly better than those in the control group, the differences were statistically significant (P＜0.05) . Conclusion　The application of Micro courses, Mini-CEX in cardiovascular medicine teaching can significantly improve students’ satisfaction and practice teaching quality, and help medical students to establish clinical thinking and master professional knowledge and skills. [ABSTRACT FROM AUTHOR]

Objective To provide scientific basis for improving the treatment efficiency of chest pain center for patients with acute myocardial infarction, comparing and analyzing the epidemiological characteristics of hospitalized patients with acute myocardial infarction before and after the establishment of chest pain center in a Grade III Level A hospital. Methods A retrospective investigation was conducted on 4445 cases of acute myocardial infarction admitted to the chest pain center of the hospital before and after the establishment of the center in 10 years. Study subjects were divided into the pre-establishment group （852 cases） and the post-establishment group （3593 cases）, and the relevant data on the first page of the medical records were statistically analyzed. Results After the establishment of chest pain center, the number of AMI patients admitted to the hospital increased by more than 3 times. There were significant increases in three important variables: the number of patients admitted through emergency care got significantly larger （P < 0.001）; the proportion of surgical cases, especially PCI cases, significantly increased （P < 0.001）, and 66.5% of patients were implanted with one or more stents （P < 0.001）; the proportion of patients who used national medical insurance increased significantly （P < 0.001）. There were significant increases in three important variables: the mortality rate among admitted patients decreased significantly （P < 0.001）; the length of hospital stay before operation reduced significantly （P < 0.05）; the cost of hospitalization has dropped significantly （P < 0.05）. Conclusions The construction of Chest Pain Center has greatly improved the efficiency and quality for AMI patients. In the treatment of AMI patients, preventive and control measures should be taken according to its epidemiological characteristics. [ABSTRACT FROM AUTHOR]

Objective: To explore the effect of establishing a WeChat platform for a chest pain center as a medium to increase the treatment speed and improve the prognosis of patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI). Methods: The chest pain center, established by the creation of a WeChat group, included primary hospitals in Chongqing that are not able to perform PPCI and the First Affiliated Hospital of Chongqing Medical University, which is the core of the center and which includes medical staff of the catheter laboratory, the cardiology department, the emergency, the vascular surgery department, and the cardiothoracic surgery department. Patients with acute STEMI who underwent PPCI from January 2017 to November 2018 in the First Affi liated Hospital of Chongqing Medical University were enrolled. The patients (including emergency department visitors, 120 callers, and patients transferred from the critical care unit or other departments) were divided into a WeChat pre-admission startup group (n = 311) and a non-WeChat pre-admission startup group (control group, n = 172). Patients ' door-to-balloon time, standard door-toballoon time achievement rate, artery puncture to balloon dilation time, heart failure rate, length of stay, and incidence of adverse events (including fatal arrhythmia, cardiogenic shock, and death) during hospitalization were compared between the two groups. Results: Four hundred eight-three consecutive patients were enrolled. There was no significant difference in patients ' sex, age, length of stay, and cardiovascular events during hospitalization between the two groups (P > 0.05). The door-to-balloon time of the patients in the WeChat pre-admission startup group was much shorter than that of patients in the non-WeChat pre-admission startup group (27.35 ± 10.58 min vs. 88.15 ± 53.79 min, P < 0.05). The standard door-to-balloon time achievement rate was signifi cantly higher in the WeChat pre-admission startup group than in the non-WeChat pre-admission startup group (100% vs. 72.09%, P < 0.05). Conclusion: The application of a WeChat platform significantly shortened the door-to-balloon time of patients receiving PPCI and increased the standard door-to-balloon time achievement rate for patients with STEMI. In addition, the platform is also conducive to integrating medical resources and sharing medical information. The establishment of the platform increased the treatment speed and improved the prognosis of patients with STEMI. [ABSTRACT FROM AUTHOR]

Background: ST-segment elevation myocardial infarction (STEMI) is a fatal cardiovascular emergency requiring rapid reperfusion treatment. During the coronavirus disease-2019 (COVID-19) pandemic, medical professionals need to strike a balance between providing timely treatment for STEMI patients and implementing infection control procedures to prevent nosocomial spread of COVID-19 among health care workers and other vulnerable cardiovascular patients.Objectives: This study evaluates the impact of the COVID-19 outbreak and China Chest Pain Center's modified STEMI protocol on the treatment and prognosis of STEMI patients in China.Methods: Based on the data of 28,189 STEMI patients admitted to 1,372 Chest Pain Centers in China between December 27, 2019 and February 20, 2020, the study analyzed how the COVID-19 outbreak and China Chest Pain Center's modified STEMI protocol influenced the number of admitted STEMI cases, reperfusion strategy, key treatment time points, and in-hospital mortality and heart failure for STEMI patients.Results: The COVID-19 outbreak reduced the number of STEMI cases reported to China Chest Pain Centers. Consistent with China Chest Pain Center's modified STEMI protocol, the percentage of patients undergoing primary percutaneous coronary intervention declined while the percentage of patients undergoing thrombolysis increased. With an average delay of approximately 20 min for reperfusion therapy, the rate of in-hospital mortality and in-hospital heart failure increased during the outbreak, but the rate of in-hospital hemorrhage remained stable.Conclusions: There were reductions in STEMI patients' access to care, delays in treatment timelines, changes in reperfusion strategies, and an increase of in-hospital mortality and heart failure during the COVID-19 pandemic in China. [ABSTRACT FROM AUTHOR]

The goal of the China chest pain center (CPC) is to optimize the diagnosis and treatment processes for patients with acute chest pain by establishing a regional cooperative rescue system. This article introduces the developing history, accreditation criteria, current status, efficiencies of accreditation, and prospects of the China CPC.

Background Chest pain center (CPC) accreditation plays an important role in the management of acute myocardial infarction (AMI). However, no evidence shows whether the outcomes of AMI patients are improved with CPC accreditation in China. Methods and Results This retrospective analysis is based on a predesigned nationwide registry, CCC‐ACS (Improving Care for Cardiovascular Disease in China‐Acute Coronary Syndrome). The primary outcome was major adverse cardiovascular events (MACE), including all‐cause death, reinfarction, stent thrombosis, stroke, and heart failure. A total of 15 344 AMI patients, from 40 CPC‐accredited hospitals, were enrolled, including 7544 admitted before and 7800 after accreditation. In propensity score matching, 6700 patients in each group were matched. The incidence of 7‐day MACE (6.7% versus 8.0%; P=0.003) and all‐cause death (1.1% versus 1.6%; P=0.021) was lower after accreditation. In multivariate adjusted mixed‐effects Cox proportional hazards models, CPC accreditation was associated with significantly decreased risk of MACE (hazard ratio: 0.78; 95% CI, 0.68–0.91) and all‐cause death (hazard ratio: 0.71; 95% CI, 0.51–0.99). The risk of MACE and all‐cause death both followed a reverse J‐shaped trend: the risk of MACE and all‐cause death decreased gradually after achieving CPC accreditation, with minimal risk occurring in the first year, but increased in the second year and after. Conclusions Based on a large‐scale national registry data set, CPC accreditation was associated with better in‐hospital outcomes for AMI patients. However, the benefits seemed to attenuate over time, and reaccreditation may be essential for maintaining AMI care quality and outcomes.

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., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Zhang, Zeng, Huang, Zhu, Peng, Liu, Luo, Yang and Wu.)

Objective: To explore whether bypassing emergency and directly calling 120 can shorten the reperfusion time of emergency PCI and improve short-term prognosis in patients with acute ST-segment elevation myocardial infarction in primary hospital chest pain center. Methods: Retrospectively analysis 405 consecutive patients with STEMI who underwent emergency PCI treatment from November 2016 to December 2018 in the Chest Pain Center of Pi Zhou People's Hospital and who met the inclusion criteria, and divided them into bypassing emergency group with 198 cases (including directly calling group with 95 cases and network-hospital referral group with 103 cases) and the non-bypassing emergency group with 207 cases. The general data and PCI-related conditions between the two groups were compared. Quality indicators of treatment: 1. baseline and 24-hour CKMB, cTnI, BNP, hs-CRP, PCT 2. ST-segment regression rate 30 min after surgery and 24-hour onset, 3. LVEF and LVDd in heart ultrasound 1 week after surgery, 4. Heart rate variability time domain indicator SDNN 1 week after surgery, 5. The incidence of MACE events and total MACE events during hospitalization, 6. bleeding complications during hospitalization, 7. hospitalization days; treatment time indicators: S2B time, S2FMC time, FMC2ECG time, FMC2DAPT time, FMC2B time, FMC2B compliance rate, D2B time, D2B compliance rate. We further conducted a subgroup analysis of the bypass emergency group, and compared the relevant indicators of the directly-calling-120 group and the network hospital referral group. 1. Results: Compared with the non- bypassing emergency group, the bypassing emergency group's mini-GRACE score was lower, the intraoperative reperfusion arrhythmia ratio was higher, and 24 hours CKMB, cTnI, BNP, hs-CRP, PCT were lower, and the ST-segment regression rate 30 min and 24-hour after surgery was higher, the LVEF was higher and the LVDd was smaller at 1 week after surgery, the SDNN was higher 1 week after surgery, the incidence of heart failure and total MACE events during hospitalization was lower, and S2B time, FMC2ECG time, FMC2DAPT time, FMC2B time, D2B time were shorter, FMC2B compliance rate and D2B compliance rate were higher, all of the difference were statistically significant (P<0.05). 2. Compared with the network-hospital referral group, the directly-calling-120 group's CKMB, cTnI, BNP, hs-CRP and PCT were lower after 24 hours, LVEF and SDNN 1 were higher, LVDd was less 1 week after surgery, the incidence of heart failure and total MACE events during hospitalization was lower, S2B time and FM2B time were shorter, and FMC2B compliance rate was higher, all of the difference were statistically significant (P<0.05). Conclusion: Bypassing emergency group and directly-calling-120 can shorten the emergency treatment time of STEMI patients in the chest pain center of the primary hospital, and can improve the prognosis. It has certain reference significance for the standardized construction of STEMI treatment in the local and other primary hospitals. [ABSTRACT FROM AUTHOR]

The data input process for most chest pain centers is not intelligent, requiring a lot of staff to manually input patient information. This leads to problems such as long processing times, high potential for errors, an inability to access patient data in a timely manner and an increasing workload. To address the challenge, an Internet of Things (IoT)-driven chest pain center is designed, which crosses the sensing layer, network layer and application layer. The system enables the construction of intelligent chest pain management through a pre-hospital app, Ultra-Wideband (UWB) positioning, and in-hospital treatment. The pre-hospital app is provided to emergency medical services (EMS) centers, which allows them to record patient information in advance and keep it synchronized with the hospital's database, reducing the time needed for treatment. UWB positioning obtains the patient's hospital information through the zero-dimensional base station and the corresponding calculation engine, and in-hospital treatment involves automatic acquisition of patient information through web and mobile applications. The system also introduces the Bidirectional Long Short-Term Memory (BiLSTM)-Conditional Random Field (CRF)-based algorithm to train electronic medical record information for chest pain patients, extracting the patient's chest pain clinical symptoms. The resulting data are saved in the chest pain patient database and uploaded to the national chest pain center. The system has been used in Liaoning Provincial People's Hospital, and its subsequent assistance to doctors and nurses in collaborative treatment, data feedback and analysis is of great significance.

At present, cardiovascular disease (CVD) prevention and control in China is in crisis. The level of acute coronary syndrome treatment and the establishment of modern treatment guidelines in China lag behind those other developed countries. The Chinese Medical Association, the Chinese Association of Cardiovascular Health, and the Cardiovascular Health Alliance have developed a program to accelerate the construction of China Chest Pain Centers (CCPC) and stringent certification requirements. The program includes (1) establishing demonstration centers in 60 cities throughout China, (2) development of guidelines for the construction and certification of regional and primary chest pain centers, (3) expansion of the number of training instructors and certification experts, (4) expansion of the scale and frequency of training, (5) quality improvements to the overall training system, and (6) quality improvements to key assessment indicators information systems and related initiatives. We propose the establishment of 40 chest pain center demonstration bases through the provision of guidance and training to 2500 hospitals toward the goals of promotion, construction, and certification of 1000 chest pain centers in China between 2016 and 2018.

What Is Already Known About This Topic?: Acute myocardial infarction (AMI) is the most serious form of cardiovascular diseases. The case fatality rate (CFR) of AMI patients is an important index to reflect the prognosis of AMI., What Is Added by This Report?: During the study period, the overall 30-day, 60-day, and 90-day CFR of AMI was 5.9%, 6.9%, and 7.6%, respectively. The CFRs in grade Ⅲ hospitals were lower than in grade Ⅱ hospitals, and the in-hospital CFR was significantly lower than that in post-discharge out-of-hospital., What Are the Implications for Public Health Practice?: This study can provide evidence for targeted prevention and highlight the need to strengthen the level of treatment of patients with AMI in grade Ⅱ hospitals., Competing Interests: No conflicts of interest., (Copyright and License information: Editorial Office of CCDCW, Chinese Center for Disease Control and Prevention 2022.)

Reducing the treatment delay by organizing delivery of care on a regional basis is a priority for improving the quality of ST-segment elevated myocardial infarction (STEMI) care. This study aimed to evaluate the impact of the combined measures on quality metrics of healthcare delivery in Suzhou. The data were collected from the National Chest Pain Center (CPC) Data Reporting Database. 4775 patients were recruited, and after propensity-score matching, 1078 pairs were finally included for analysis. We examined the changes in quality metrics of care including prehospital and in-hospital processes, and clinic outcomes. Quality improvement (QI) implementation improved most process indicators. However, these improvements did not yield decreased in-hospital mortality. The door-to-balloon and the FMC-to-device time decreased from 85.0 and 98.0 min to 78 and 88 min, respectively ( p < 0.001). Cases transferred directly via EMS had a greater improvement in most of process indicators. The proportion of patients transferred directly via EMS was 10.3%, much lower than that of self-transported patients at 58.3%. Tertiary hospitals showed greater performance improvement in process indicators than secondary hospitals. The percentage of cases using EMS remained low for suburban areas. The establishment of coordinated STEMI care needs to be accompanied with solving the fragmented situation of the prehospital and hospital care, and patient delay should be addressed, especially in suburban areas and on transferred-in inpatients.

ST-segment elevation myocardial infarction (STEMI) is a common cardiovascular emergency for which timely reperfusion therapies are needed to minimize myocardial necrosis. The aim of this study was to investigate the impact of the COVID-19 pandemic and reorganization of chest pain centers (CPC) on the practice of primary percutaneous coronary intervention (PPCI) and prognosis of STEMI patients. This single-center retrospective survey included all patients with STEMI admitted to our CPC from January 22, 2020 to April 30, 2020 (during COVID-19 pandemic in Wuhan), compared with those admitted during the analogous period in 2019, in respect of important time points of PPCI and clinical outcomes of STEMI patients. In the present article, we observed a descending trend in STEMI hospitalization and a longer time from symptom onset to first medical contact during the COVID-19 pandemic as compared to the control period (4.35 h versus 2.58 h). With a median delay of 17 minutes in the door to balloon time (D2B), the proportion of in-hospital cardiogenic shock was significantly higher in the COVID-19 era group (47.6% versus 19.5%), and major adverse cardiac events (MACE) tend to increase in the 6-month follow-up period (14.3% versus 2.4%). Although the reorganization of CPC may prolong the D2B time, immediate revascularization of the infarct-related artery could be offered to most patients within 90 minutes upon arrival. PPCI remained the preferred treatment for patients with STEMI during COVID-19 pandemic in the context of timely implementation and appropriate protective measures., Competing Interests: The authors of this study have no conflicts of interest to declare., (© 2021 The Authors. Published by IMR Press.)

Objective: To explore the comprehensive effect of exercise-based cardia crehabilitation in patients managed with medical alliance who have undergone percutaneous coronary intervention (PCI) from Chest Pain Center. Methods: A total of 91 post PCI patients with coronary atherosclerotic heart disease were enrolled into the study. Fifty-four patients were in exercise rehabilitation group and 37 patients were in control group according to whether they were managed with medical alliance. Scores of Short Form -36 Health Survey (SF-36),qualified rate of blood pressure, blood glucose, blood lipid and incidence of MACEs of patients were compared at discharge, 1 month after discharge and 3 months after discharge between two groups. Results: The qualified rate of blood lipid of patients in exercise rehabilitation group was significantly higher than that in control group 3 months after discharge ( P< 0.05). There was significant difference in Scores of physical functioning, role-physical (RP), general health (GH), vitality (VT), social functioning (SF), role-emotional (RE), mental health (MH) and Quality of Life (QL) between the two groups 1 month after discharge( P< 0.05)and there was significant difference in Scores of RP, GH, VT, SF, RE, MH and QL between the two groups 3 months after discharge( P< 0.05). Conclusion: Medical alliance management has positive effects on patients who have undergone PCI from Chest Pain Center, improves the motor function and quality of life. Therefore, it is worthy of promotion with the support of the policy.

Introduction: Successful ST-segment elevation myocardial infarction (STEMI) management is time-sensitive and is based on prompt reperfusion mainly to reduce patient mortality. It has evolved from a single hospital care to an integrated regional network approach over the last decades. This prospective study, named the China STEMI Care Project (CSCAP), aims to show how implementation of different types of integrated regional STEMI care networks can improve the reperfusion treatment rate, shorten the total duration of myocardial ischaemia and lead to mortality reduction step by step., Methods and Analysis: The CSCAP is a prospective, multicentre registry study of three phases. A total of 18 provinces, 4 municipalities and 2 autonomous regions in China were included. Patients who meet the third universal definition of myocardial infarction and the Chinese STEMI diagnosis and treatment guidelines are enrolled. Phase 1 (CSCAP-1) focuses on the in-hospital process optimisation of primary percutaneous coronary intervention (PPCI) hospitals, phase 2 (CSCAP-2) focuses on the PPCI hospital-based regional STEMI care network construction together with emergency medical services and adjacent non-PPCI hospitals, while phase 3 (CSCAP-3) focuses on the whole-city STEMI care network construction by promoting chest pain centre accreditation. Systematic data collection, key performance index assessment and subsequent improvement are implemented throughout the project to continuously improve the quality of STEMI care., Ethics and Dissemination: The study has been reviewed and approved by the Ethics Committee of Peking University First Hospital. Ranking reports of quality of care will be generated available to all participant affiliations. Results will be disseminated via peer-reviewed scientific journals and presentations at congresses., Trial Registration Number: NCT03821012., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)