Effectiveness of a New Regional Network on STEMI Care in an Under-developed Area of Southwest China

Abstract

AbstractBackgroundST-elevation myocardial infarction (STEMI) is life-threatening and need time-critical care. A new prefecture-wide STEMI Network was implemented in Chuxiong, Yunnan, China, the first reported STEMI network in underdeveloped area. How the Network impacted STEMI care in the prefecture has not previously been evaluated. The study aims to estimate the efficacy of the STEMI Network.MethodsA longitudinal study including 5-years STEMI patients covering the pre-network, creation and post-network phase was conducted to assess the changes of STEMI care. Outcomes including timely presentation, reperfusion therapy, timely reperfusion, heart failure, inpatient mortality, length of hospital stay, in-hospital charge, and various intervals of ischemic time (total ischemic time, patient delay, system delay, diagnosis time, reperfusion delay, Z to N time, Z to W time) were compared among the three Network phases.ResultsA total of 1436 STEMI patients (380 in pre-network, 375 in creation and 681 in post-network phases) were included. Significantly increasing proportions of timely presentation (71.3%, 73.3%, 81.4%) and reperfusion (58.2%, 59.2%, 65.3%) were found over the 3 phases. Compared with pre-network patients, post-network patients had shorter medians of patient delay (193 vs. 215 minutes), total ischemic time (348 vs. 380 minutes) and system delay (152 vs. 174 minutes). A significant decreasing trend of heart failure was observed (11.1%, 8.8%, 7.0%) across network phases. After conditioning, post-network patients were more likely than pre-network patients to have timely presentation (OR=1.70 [1.26, 2.30]), receive reperfusion therapy (OR=1.33 [1.02, 1.73]), and have shorter patient delay (HR=1.23 [1.08,1.40]) and total ischemic time (HR=1.22 [1.03,1.44]), but were less likely to receive timely reperfusion (OR=0.55 [0.36, 0.84]), timely PCI (OR=0.55 [0.34, 0.86), and shorter Z to W time (HR=0.78 [0.65, 0.94).ConclusionImprovements of STEMI reperfusion care by the regional Network were evident in this under-developed area; however, timely reperfusion care still needs to be enhanced.