Objective To search, evaluate and summarize the relevant evidence of the treatment and management of patients with acute myocardial infarction (AMI) under the chest pain center mode by using the evidence-based medicine method, so as to provide references for optimizing the clinical pathway, improving the medical quality and improving the prognosis of patients. Methods Relevant evidence on the treatment and management of AMI patients in relevant databases and websites at home and abroad was retrieved, and the retrieval time limit was from the establishment of databases to January 1, 2025. The quality of the included literature was evaluated, and the evidence was extracted and summarized. Results A total of 15 articles were included, including 2 clinical decisions, 2 systematic reviews, 8 guidelines, and 3 expert consensuses. Finally, 23 pieces of best evidence were extracted, including the basic conditions of chest pain center, the evaluation and treatment of patients with acute chest pain, the integration of pre-hospital emergency system and hospital green channel, and training and education. Conclusions The best evidence for the treatment and management of AMI under the chest pain center mode can provide evidence-based basis for clinical practice. It is necessary to combine the situation of the chest pain center, fully consider the validity and feasibility of the evidence, and help the chest pain center improve the medical quality and improve the prognosis of patients in a standardized and scientific way.
Objective To explore the clinical features and diagnostic procedure of atypical asthma characteristic of chest pain.Methods The patients with unexplained chest pain were screened by lung function test and bronchial provocation test.The diagnosis of asthma was established by therapeutic test and exclusive procedure.The clinical manifestations were analyzed.Results In 56 cases of unexplained chest pain 20 cases were diagnosed as asthma.While all patients referred to clinic with chest pain as chief complaint，a majority of patients (11 cases，85%) showed obscure chest tightness，breath shortness and cough..Some cases reported the same trigger factors as asthma.Chest pain was relieved in all cases after regular antiasthma treatments.Conclusions Chest pain could be a specific presentation of asthma which may be misdiagnosed as other diseases.Bronchial provocation tests and antiasthma therapy should be considered to screen and diagnose this atypical asthma.
ObjectiveTo investigate the effectiveness of establishment of chest pain center and optimized process in the diagnostic and treatment progress and short-term prognostic value of acute non-ST segment elevation myocardial infarction (NSTEMI) patients. MethodsThis was a retrospective study. We included NSTEMI patients admitted in the Emergency Department in our hospital, 41 patients admitted before the establishment of the chest pain center (April 2015) were included as group A (30 males and 11 females at age of 64.7±11.8 years), 42 patients after the establishment of the chest pain center (April 2016) as group B (31 males and 11 females at age of 64.6±11.8 years), and 38 patients after the establishment of the chest pain center (April 2017) as group C (30 males and 8 females at age of 62.6±10.0 years). The clinical outcomes of the three groups were compared.ResultsThe time from admission to electrocardiogram was 20.0 (17.0, 25.5) min in the group A, 4.0 (2.8, 5.0) min in the group B, and 3.0 (2.0, 4.0) min in the group C (P<0.001). The first doctor's non-electrocardiogram advice time was 13.0 (10.0, 18.0) min, 9.5 (6.8, 15.3) min, and 9.0 (7.0, 12.0) min (P=0.001) in the three groups, respectively. The diagnostic confirmed time was 139.4±48.5 min, 71.1±51.5 min, 63.9±41.9 min (P<0.001). The proportion of patients receiving emergency dual anti-platelet load dose treatment was 53.1%, 70.0%, 100.0% (P=0.001), respectively. The time of receiving emergency dual anti-platelet load dose treatment was 208.0 (72.0, 529.0) min, 259.0 (91.0, 340.0) min, and 125.0 (86.0, 170.0) min (P=0.044) in the three groups, respectively. Emergency percutaneous coronary artery intervention (PCI) start time was 60.9 (42.1, 95.8) hours, 61.3 (43.3, 92.2) hours, 30.5 (2.8, 44.1) hours (P<0.001) in the three groups, respectively. Among them, the moderate risk patients’ PCI starting time was 63.0 (48.1, 94.2) hours, 62.3 (42.1, 116.2) hours, and 40.1 (17.2, 60.4) hours (P>0.05), respectively. The high risk patients’ PCI starting time was 47.9 (23.7, 102.4) hours, 55.2 (44.0, 89.6) hours, 23.2 (1.7, 41.8) hours in the three groups, respectively (P<0.001). The hospitalization time of the patients was 7.0 (5.4, 9.4) days, 5.9 (4.9, 8.7) days, 4.7 (3.1, 6.2) days in the three groups (P<0.001), respectively. The hospitalization time of the moderate risk patients was 6.9 (4.9, 8.8) days, 6.4 (4.9, 8.0) days, 4.8 (3.2, 6.5) days in the three groups (P>0.05), respectively. The hospitalization time of the high risk patients was 7.1 (5.5, 9.9) days, 5.9 (4.6, 9.8) days, and 4.4 (3.0, 6.1) days, respectively (P<0.001). The fatality rate of inpatients was 4.9%, 0.0%, and 0.0%, respectively (P>0.05). The correlation coefficient of hospitalization time, diagnosis confirmed time and PCI starting time was 0.219 and 0.456 (P<0.05), respectively.ConclusionThe establishment and optimized process of chest pain center can accelerate the time of early diagnosis of NSTEMI, which is helpful to obtain stratified and graded standardized treatment for patients according to their conditions, to accelerate the specific treatment process of high risk NSTEMI patients, and shorten the hospitalization time.
Objective To explore the effect of first aid mode based on intelligent chest pain center on the rescue effect of patients with acute myocardial infarction (AMI). Methods AMI patients treated in the Second Hospital of Baoding between May 2020 and September 2023 were retrospectively selected. Patients who received traditional chest pain emergency mode between May 2020 and January 2022 were selected as the control group, and patients who received intelligent chest pain center model between February 2022 and September 2023 were selected as the study group. The first aid success rate, first aid time (first visit time, 120 arrival time, triage evaluation time, venous channel opening time, and electrocardiogram time), treatment timeliness [first medical contact to balloon time (FMC-to-B), door to balloon time (D-to-B), stent placement time, emergency stay time, and hospitalization time], basic vital signs (systolic blood pressure, heart rate, and respiratory rate), incidence of complications and family first aid satisfaction were compared between the two groups. Results A total of 98 patients were included, including 50 in the study group and 48 in the control group. There was no significant difference in the success rate of first aid between the study group and the control group (96.0% vs. 83.3%, P>0.05). The first visit time [(203.15±33.82) vs. (260.71±41.05) min], 120 arrival time [(10.45±1.61) vs. (14.02±2.31) min], triage evaluation time [(1.07±0.21) vs. (1.71±0.33) min], venous channel opening time [(1.31±0.16) vs. (2.95±0.42) min], electrocardiogram time [(5.52±1.08) vs. (6.89±1.38) min], FMC-to-B [(115.82±31.74) vs. (145.29±46.15) min], D-to-B [(78.15±30.41) vs. (112.53±34.12) min], stent placement time [(45.01±8.36) vs. (71.85±9.67) min], emergency stay time [(38.24±9.81) vs. (59.46±11.05) min] and hospitalization time [(12.98±1.27) vs. (15.31±1.80) d] were shorter in the study group than those in the control group (P<0.05). After first aid, the systolic blood pressure [(133.49±13.16) vs. (142.69±12.58) mm Hg (1 mm Hg=0.133 kPa)], heart rate [(90.26±18.25) vs. (103.69±17.49) beats per minute], respiratory rate [(22.15±2.87) vs. (24.87±3.08) breaths per minute] and complication rate (10.4% vs. 27.5%) in the study group were lower than those in the control group (P<0.05). The first aid satisfaction of family members was higher in the study group than that in the control group (97.9% vs. 82.5%, P<0.05). Conclusion The first aid model based on intelligent chest pain center can improve the success rate of first aid treatment for AMI patients, shorten the first aid treatment time, enhance the time effectiveness of treatment, stabilize the basic vital signs of patients, reduce the incidence of complications, and improve the satisfaction of family members with first aid treatment.
The Medical Administration and Hospital Administration of the National Health Commission released the "2021 China Chest Pain Center Quality Control Report" in January 2022. This report analyzes the construction ratio of chest pain centers in the second-level and above medical institutions nationwide in 2021 and the construction of standard and basic chest pain centers, mainly from the way of coming to the hospital, symptom onset to first medical contact time, door to wire time, reperfusion therapy ratio, in-hospital mortality, proportion of discharges with medication recommended by the guidelines and average length and cost of hospital stay of ST-segment elevation myocardial infarction patients to comprehensively describe the current status of the construction of the national chest pain centers. This article interprets the report in detail by reviewing relevant literature.
The American Heart Association and other six major associations jointly released AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain for the first report on October 28th, 2021. This guideline stresses the risk stratification and the diagnostic workup of acute chest pain, considers the cost-effectiveness of low-risk chest pain diagnosis and examination, and recommends sharing decisions with patients. This guideline mainly involves the initial evaluation of chest pain, choosing the right pathway with patient-centric algorithms for acute chest pain, and the evaluation of patients with stable chest pain. This review makes a detailed interpretation of the recommended points of the guideline through reviewing the literature.
目的：了解有癥狀冠狀動脈異常患者的臨床特點和預后。方法：搜集1999年11月~2005年10月期間，因胸痛在心導管室行冠狀動脈造影的病例，分析冠狀動脈異常患者所占構成比，對該類患者進行隨訪，分析其臨床特點及臨床終點事件(死亡、心臟猝死、心肌梗死以及血運重建等)的發生情況。結果：在研究期間，共2003例胸痛患者進行了冠狀動脈造影，74例患者有冠狀動脈異常(構成比3.7%)，包括心肌橋54例、冠狀動脈瘺16例、冠狀動脈異常起源3例、單支冠狀動脈1例。其中23名冠狀動脈異常患者伴發有嚴重的冠狀動脈粥樣硬化病變或主動脈瓣病變。對無上述伴發疾病的冠狀動脈異常患者進行隨訪，在隨訪期內(平均隨訪40月)，與冠狀動脈正常患者相比，該類患者臨床終點事件發生率無差異。結論：在有胸痛癥狀行冠狀動脈造影的患者中，冠狀動脈異常的構成比較低。該類患者的臨床預后近似于冠狀動脈正常患者。
ObjectivesTo systematically review clinical values of multi-slice spiral computed tomography angiography (MSCTA) in diagnosis of chest pain triple (CPT).MethodsPubMed, EMbase, The Cochrane Library, Web of Science, CNKI, CBM, VIP and WanFang Data databases were searched to collect diagnostic tests on CPT diagnosed by MSCTA from inception to October 2017. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of the included studies. Meta-analysis was performed by Stata 12.0 software. The pooled weighted Sen, Spe, +LR, -LR, and the DOR were calculated, SROC and AUC were drawn.ResultsA total of 11 diagnostic studies were included. The results of meta-analysis showed that the pooled Sen, Spe, +LR, -LR, DOR and AUC of MSCTA for diagnosing CPT were 0.95 (95%CI 0.91 to 0.98), 0.97 (95%CI 0.94 to 0.98), 31.24 (95%CI 15.63 to 62.43), 0.05 (95%CI 0.02 to 0.10), 659.04 (95%CI 236.73 to 1 834.71) and 0.99 (95%CI 0.98 to 1.00), respectively.ConclusionsMSCTA has high sensibility and specificity for diagnosing CPT. Due to limited quantity and quality of the included studies, more high-quality studies are required to verify the above conclusion.