|Year : 2019 | Volume
| Issue : 2 | Page : 58-61
Effect of WeChat platform on ST-segment elevation acute myocardial infarction reperfusion treatment time and curative effect
Shuxin Hou, Damin Huang, Jinchun Zhang, Zhihua Li, Honglei Zhang, Hongqiang Liu, Yingmin Lu
Department of Cardiovascular Medicine, Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
|Date of Submission||22-Oct-2018|
|Date of Acceptance||22-Oct-2018|
|Date of Web Publication||26-Jun-2019|
Department of Cardiovascular Medicine, Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, 202150
Source of Support: None, Conflict of Interest: None
Objective: The objective of the study is to construct a regional ST-segment elevation myocardial infarction (STEMI) treatment network system using the WeChat platform as a carrier and to explore the effect of this system on the time to reperfusion treatment and efficacy of treatment for patients with acute STEMI. Materials and Methods: The Department of Cardiology at our hospital constructed a STEMI rescue WeChat group including 120 emergency departments and acute care hospitals in the district. For all suspected STEMIs, relevant medical history data were uploaded to the WeChat group, a physician from the Department of Cardiology was consulted electronically, and this cardiologist was able to inform the local physician of a reperfusion treatment plan. One hundred and seventy-seven STEMI patients were transferred to our hospital within 12 h of presentation, of which 81 cases were transferred before the establishment of the WeChat group (the control group), and 96 cases were transferred using the WeChat system (WeChat group). The time to reperfusion, O-to-FMC time, FMC-to-B time, D-to-B time, average hospitalization stay, and mortality during hospitalization were observed and compared between the two groups. Results: The WeChat group had a lower O-to-FMC time compared with the control group, but this difference was not statistically significant. The FMC-to-B time, the time of D-to-B, and the average days of hospitalization in the WeChat group were all lower compared with those in the control group. The incidence of cardiovascular events and the heart function ratio of the patients after 6 months were compared, and the WeChat group was statistically superior to the control group in relation to these outcomes. Conclusion: The establishment of a STEMI regional treatment network based on the WeChat platform can shorten the time to reperfusion treatment, reduce postreperfusion cardiovascular events, shorten the days of hospitalization, and improve the heart function of patients.
Keywords: Acute myocardial infarction, coronary heart disease, curative effect, reperfusion, WeChat
|How to cite this article:|
Hou S, Huang D, Zhang J, Li Z, Zhang H, Liu H, Lu Y. Effect of WeChat platform on ST-segment elevation acute myocardial infarction reperfusion treatment time and curative effect. Cardiol Plus 2019;4:58-61
|How to cite this URL:|
Hou S, Huang D, Zhang J, Li Z, Zhang H, Liu H, Lu Y. Effect of WeChat platform on ST-segment elevation acute myocardial infarction reperfusion treatment time and curative effect. Cardiol Plus [serial online] 2019 [cited 2019 Sep 16];4:58-61. Available from: http://www.cardiologyplus.org/text.asp?2019/4/2/58/261431
| Introduction|| |
Acute ST-segment elevation myocardial infarction (STEMI) occurs due to acute myocardial ischemia and necrosis, mostly in the setting of coronary artery disease, causing decreased coronary artery blood flow. The pathological etiology is usually secondary to thrombosis of the coronary arteries associated with unstable plaques. It is a common emergency seen in the emergency department and within the Department of Cardiology. STEMI often presents with persistent chest pain and other symptoms, can cause serious arrhythmias, heart failure, and even sudden death, seriously affecting the quality of life and the life of patients, and causing a huge burden on the family and society. If proper treatment occurs in a timely manner, the mortality rate and complications from STEMI are greatly reduced, and the prognosis for patients is improved. The mortality rate from STEMI is high, and prognosis is closely related to time to reperfusion., To improve the quality of STEMI treatment in this district, we carried out the study described here.
| Materials and Methods|| |
During the period from January 1 to December 31, 2017, 177 cases of suspected STEMI were transferred to our hospital within 12 h for the purpose of percutaneous coronary intervention (PCI). Cases referred between January 1 and June 30, 2017 were designated as the control group (STEMI treatment before the establishment of the WeChat platform). The control group comprised 81 cases. Ninety-six cases were transferred during the period from July 1 to December 31, 2017 (after the establishment of the WeChat system) and were designated as the observation group (WeChat group). There were no contraindications for anticoagulation or antiplatelet therapy for any included patients, and signed informed consent was obtained. The study was approved by the Ethics Committee of the Chongming Branch of Xinhua Hospital, affiliated to Shanghai Jiaotong University School of Medicine. Exclusion criteria included those patients with Takayasu's arteritis, severe renal insufficiency, dialysis treatment, radial artery weakness, previous coronary artery bypass surgery, and those who refused to participate in the study were excluded.
Under the leadership of the District Health Planning Commission, to construct the regional network system of which the Department of Cardiology in our hospital as the core, the 120 emergency system as a link, the primary hospitals in the district and the emergency departments that did not carry out emergency intervention hospitals as the outlets. During the treatment of STEMI patients, the first doctor had an electrocardiogram examination according to the requirements of the guide and uploaded the basic information of the electrocardiogram and the medical history data to the WeChat platform. The Department of Cardiology professional doctors consulted the electrocardiogram and the patient information, according to the symptoms and electrocardiogram confirmed STEMI, the patients were immediately referred them to our hospital by 120 ambulances. Emergency intervention therapy was started for the patients within 12 h of the disease. Notify the general practitioner, 120 doctors or the first doctor of the emergency department to immediately give the patient 300 mg of aspirin chewing load and 300 mg of clopidogrel orally. The “green channel” was sent directly into the hospital's catheter room, and the emergency PCI was performed. Postoperative patients were admitted to the department of cardiology cardiac care unit (CCU).
Before the establishment of the Wechat platform, patients were referred to our hospital for routine referral. After arriving at the emergency department of our hospital, they contacted the cardiologist of our hospital for consultation. After the diagnosis of STEMI, they were given 300 mg aspirin chewing and 300 mg clopidogrel orally. They were directly sent to the catheter room of our hospital through the “green channel” for emergency PCI. After the operation, patients were admitted to in the Department of Cardiology CCU.
All the patients over 75 years old would not have load aspirin and clopidogrel. The patients who refused early reperfusion therapy with heart disease in the Department of Cardiology were directly admitted to the CCU. All patients were treated with conventional statins, angiotensin-converting enzyme inhibitors, beta-blockers and low molecular weight heparin on the basis of dual antiplatelet drugs according to their condition.
The observation index included O-to-FMC time, FMC-to-B time, FMC-to-B time standard rate, D-to-B time, the average hospitalization days, and the hospitalization of cardiovascular events in patients and heart function indexes.
Statistical analysis was performed using SPSS 19 software (IBM (International Business Machines Corporation), New York City in America), and the measurement data to mean + standard deviation were compared by t-test, count data in percentage (%), comparison between groups using Chi-square test. Nonnormal distribution data are represented by median and nonparametric test. The difference between P < 0.05 is statistically significant.
| Results|| |
General data of the WeChat group and the control group
Before the establishment of the WeChat platform, there were 81 patients in the control group, including 52 males and 29 females, mean age 64 + 17.23 years old, 38 cases of anterior descending branch of the offender, 22 cases of right coronary artery, and 21 cases of left circumflex. The blood flow of the criminals vessels was thrombolysis in myocardial infarction 1 (TIMI1) grade in 1 case and the other was TIMI3 after emergency PCI. There were 96 cases in the observation group (WeChat group), 60 males and 36 females among them, age 60 + 29 years old. There were 46 cases of anterior descending branch of the offender, 24 cases of right coronary artery, and 24 cases of circumflex artery. After emergency PCI, the blood flow of the offenders was TIMI3 grade, as shown in [Table 1].
WeChat group and control group patients undergoing reperfusion therapy and length of stay
Comparing the time related to reperfusion therapy between Weixin group and control group, it was found that: The difference of patients with onset to the first medical contact time (O-to-FMC time) had no statistical difference, P > 0.05. The time of referral and D-to-B in the WeChat group were significantly shorter than those in the control group, with statistical significance, P < 0.05; the rate of early reperfusion was 82% versus 68%, and the WeChat group was significantly higher than the control group, with statistical significance, P < 0.05; and the number of WeChat groups in the hospital days was significantly shorter than the control group, with statistical significance, P < 0.05 [Table 2].
|Table 2: Comparison of reperfusion time and length of stay between the WeChat group and control group|
Click here to view
Cardiovascular events and cardiac function in the WeChat group and control group
Compared with the control group, the incidence of re-infarction, cardiac arrest, acute heart failure, cardiogenic shock and cardiogenic death in the observation group were 12.5% and 19.75% respectively, but there was no significant difference (P > 0.05). See [Table 3].
|Table 3: Comparison of cardiovascular events between the WeChat group and control group|
Click here to view
In terms of heart function index, on comparison between the WeChat group and the control group patients, BNP of patients in the observation group were lower than the control group at admission and after June, LVEF of patients in the observation group were higher than the control group, after 1 weeks and after June, there were significant differences in P < 0.05. See [Table 4].
| Discussion|| |
In patients with acute myocardial infarction, the blood flow of the criminals is interrupted. With the prolongation of the ischemia time, the damaged myocardium is necrotic and reperfusion should be taken as soon as possible. The maximum shortening of the ischemic time and improving the blood flow of the infarcted vessels can save the dying myocardium, reduce the infarct area, inhibit or reverse the ventricular remodeling, and improve the acute myocardial infarction. The success rate of treatment is the key factor to improve the quality of life and prognosis of patients. In a 1994–2001 year study of 1791 STEMI patients with direct PCI, the total ischemic time was 30 min longer and the 1-year mortality rate increased by 7.5%. About 2 million 500 thousand of patients with acute myocardial infarction in our country every year, most of them miss the golden time of treatment, with the delay of treatment time, myocardial cell necrosis progrediens, increase mortality. PCI is the most convenient and effective method of reperfusion therapy. This is clearly recommended in the guidelines., The clinical results showed that the mortality rate of acute myocardial infarction treated with drugs was 10% ~ 15%, the mortality rate with thrombolytic therapy was 8%, and the mortality wit interventional therapy was <5%.,
China's interventional direct report data suggest that since 2009, emergency PCI data in our country have increased gradually, but in 2014, emergency PCI only accounts for 33.49% of acute STEMI, and emergency PCI only accounts for 5% of all PCI numbers, that is to say, 66.51% of acute STEMI missed the emergency due to delay in visiting time and so on. 95% of patients with acute ST-segment elevation myocardial infarction failed to receive emergency PCI treatment and missed the best treatment time., In recent years, with the strengthening of the hardware construction of various major hospitals and the construction of acute myocardial infarction green channel, the delay in hospital time is obviously shortened, but the success rate of STEMI treatment has not been significantly improved. At present, the delay in the treatment of acute myocardial infarction is mainly due to the delay of patients'visits and the high consumption of pre-hospital time., In 2016, Shanghai Putuo District Central Hospital explored the regional chest pain center mode to further shorten the reperfusion time of STEMI patients and reduce the short-term mortality rate.
Chongming Island is located in the Yangtze River Estuary islands with wide region about 1267 km2, is the third largest island in China, with approximately 800 thousand residents, and has huge population prevalence of cardiovascular disease. Our hospital is the only three grade hospital in Chongming Island and is the Chongming Island medical rescue center. However, because of the bar of Yangtze River, traffic is extremely inconvenient. The medical conditions on the island are far behind the three grade hospitals in Shanghai and other parts of the country. Primary doctors are weak in the early diagnosis of acute myocardial infarction after the onset of the disease, After the onset of the disease, patients call 120 or go to the grass-roots hospital nearby, transfer to our hospital for definite diagnosis before preoperative preparation, and then start the interventional therapy team is losing a lot of time. In this study, using the WeChat platform to transmit patients' medical history data, a regional treatment model based on the WeChat platform is established, which is economical and convenient. Compared with the traditional treatment transfer mode, the FMC-to-B time, D-to-B time, TNI peak time, and the number of days of hospitalization can be significantly shortened, and the rate of early perfusion is improved, and the incidence of cardiovascular events during hospitalization is reduced.
| Conclusion|| |
To sum up, the regional treatment mode of Wechat platform can further shorten the time of myocardial ischemia, improve the early reperfusion rate, and then improve the cardiac function of patients, and improve the quality of treatment of STEMI patients in this region.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Smith FG, Brogan RA, Alabas O, Laut KG, Quinn T, Bugiardini R, et al.
Comparative care and outcomes for acute coronary syndromes in Central and Eastern European transitional countries: A review of the literature. Eur Heart J Acute Cardiovasc Care 2015;4:537-54.
Liu X, Li Y, Jiang Y, Hu N, Zhao WH. Disease burden of acute myocardial infarction in China in 2010. China chronic disease prevention and control 2013;21:271-3.
Boeddinghaus J, Reichlin T, Nestelberger T, Twerenbold R, Meili Y, Wildi K, et al.
Early diagnosis of acute myocardial infarction in patients with mild elevations of cardiac troponin. Clin Res Cardiol 2017;106:457-67.
Lv J, Liang Y, Yan J, Wang Z, Xu L. A new regional cooperative treatment model for acute ST segment elevation myocardial infarction. Chin Hosp Manage 2015;35:31-3.
Xu L, Ma Y. Current research on curative effect of delayed percutaneous coronary intervention in St-segment elevation acute myocardial infarction. Adv Cardiol 2015;36:277-9.
Authors/Task Force members, Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, et al.
2014 ESC/EACTS guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2014;35:2541-619.
Tao H. My opinion about that updated guidelines for diagnosis and treatment of acute ST-segment elevation myocardial infarction, European Heart Association, 2017. Chin J Interv Cardiol 2017;25:483-5.
Wang L, Zhou Y, Qian C, Wang Y. Clinical characteristics and improvement of the guideline-based management of acute myocardial infarction in China: A national retrospective analysis. Oncotarget 2017;8:46540-8.
Wan F, Zhang T, Shen L, Pu J, Song W, Du Y, et al
. Early routine post-thrombolysis percutaneous coronary intervention vs. primary PCI in ST-segment elevated myocardial infarction: A comparative study. Chin J Interv Cardiol 2013;21:3-7.
Li J, Li X, Hu S, Yu Y, Yan XF, Jiang LX. ST-segment elevation myocardial infarction in the eastern urban China: from 2001 to 2011. Chinese Journal of Cardiology 2016;44:303-8.
Tong S, Chen Y, Li T, Cao F. Current situation and challenges of diagnosis and treatment of acute coronary syndrome in China. J Transl Med 2015;4:338-41.
Liu X, Yu S, Liu H. Effect of reperfusion therapy on STEMI patients transported by regional cooperative rescue system. Chin J Disaster Med 2016;4:246-9.
Nakamura M, Yamagishi M, Ueno T, Hara K, Ishiwata S, Itoh T, et al.
Current antiplatelet therapy for Japanese patients with ST elevation acute myocardial infarction: J-AMI registry. Cardiovasc Interv Ther 2013;28:162-9.
Shen J, Jin H, Liu Z, Ou S, Yang W, Wang Z, et al
. Influence of different transport modes on the efficacy of direct percutaneous intervention in acute ST elevation myocardial infarction. China Clin Med 2016;23:25-7.
http://www.cmx.gov.cn/cm_website/html/DefaultSite/shcm_xwzx_yxcm_cmgk/2009-04-21/Detail_11127.htm. [Last accessed on 2018 Aug 20].
[Table 1], [Table 2], [Table 3], [Table 4]