Chest Pain Center Accreditation Is Associated With Improved In-Hospital Outcomes of Acute Myocardial Infarction Patients in China: Findings From the CCC-ACS Project
Chest Pain Center Accreditation Is Associated With Improved In-Hospital Outcomes of Acute Myocardial Infarction Patients in China: Findings From the CCC-ACS Project
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DOI：
10.1161/jaha.119.013384
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发表时间：
2019-11-05
影响因子：
5.4
通讯作者：
Ou, Zhihong
中科院分区：
文献类型：
--
作者：
Fan, Fangfang;Li, Yuxi;Ou, Zhihong
背景：胸痛中心（CPC）认证在急性心肌梗死（AMI）的治疗中起着重要作用。然而，没有证据表明中国CPC认证是否改善了AMI患者的预后。方法和结果：本回顾性分析基于预先设计的全国登记，CCC-ACS（改善心血管疾病在中国的护理-急性冠脉综合征）。主要终点是主要不良心血管事件（MACE），包括全因死亡、再梗死、支架血栓形成、中风和心力衰竭。共纳入来自40家中国共产党认可医院的AMI患者15 344例，其中认可前入院7544例，认可后入院7800例。在倾向评分匹配中，每组匹配6700例患者。7天MACE发生率（6.7%对8.0%;P-0.003）和全因死亡发生率（1.1%对1.6%;P-0.021）在鉴定后较低。在多因素调整的混合效应Cox比例风险模型中，CPC认证与MACE（风险比：0.78;95% CI: 0.68-0.91）和全因死亡（风险比：0.71;95% Cl: 0.51-0.99）的显著降低相关。MACE和全因死亡风险均呈反j型趋势：获得CPC认证后，MACE和全因死亡风险逐渐下降，第一年风险最小，第二年及之后风险增加。结论：基于大规模的国家注册数据集，CPC认证与AMI患者更好的住院预后相关。然而，益处似乎随着时间的推移而减弱，重新认证可能对维持AMI护理质量和结果至关重要。
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% Cl, 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.