北京大学第一医院Yong Huo、北京大学公共卫生学院Zhi-Jie Zheng等合作取得一项新成果。经过不懈努力，他们利用国家胸痛中心项目（NCPCP）的证据揭示了中国急性冠脉综合征患者（ACS）管理和预后的地区差异。2024年3月4日出版的《科学通报》杂志发表了这项成果。

研究人员使用广义线性混合模型和交互分析，评估了国家胸痛中心项目与地区性ACS医疗服务差异之间的关联。西部地区患者从发病到首次接触治疗（FMC）的时间和在非PCI医院的住院时间较长，ST段抬高型心肌梗死（STEMI）患者经皮下冠状动脉介入治疗（PCI）率较低，用药率较高。中部地区患者的院内死亡率和院内心力衰竭发生率相对较低。

通过审查后，西部地区和东部地区门到气球时间（DtoB）和院内死亡率差异较小（β=-8.82，95%置信区间[CI]-14.61至-3.03；OR=0.79，95%CI 0.70至0.91）。中部地区和东部地区在DtoB时间、STEMI初级PCI率方面的差异结果相似。不同地区高风险非ST段抬高急性冠脉综合征（NSTE-ACS）患者的PCI差异较小。

此外，东西部地区的用药差异更大。中国参与NCPCP的大型医院中，ACS患者的地区差异仍然很大。需要采取更全面的干预措施并优化医院内部系统，以进一步减少ACS患者管理和预后的地区差异。

据悉，急性冠状动脉综合征管理和愈后的地区差异一直是一个巨大的公共卫生问题。然而，有关如何减少这种差异的研究仍有待探索。国家胸痛中心项目是中国首个以医院为基础的全国性综合持续质量改进项目，旨在提高急性冠脉综合征患者的医疗质量。

附：英文原文

Title: Regional variations in management and outcomes of patients with acute coronary syndrome in China: Evidence from the National Chest Pain Center Program

Author: anonymous

Issue&Volume: 2024/03/04

Abstract: Regional variations in acute coronary syndrome (ACS) management and outcomes have been an enormous public health issue. However, studies have yet to explore how to reduce the variations. The National Chest Pain Center Program (NCPCP) is the first nationwide, hospital-based, comprehensive, continuous quality improvement program for improving the quality of care in patients with ACS in China. We evaluated the association of NCPCP and regional variations in ACS healthcare using generalized linear mixed models and interaction analysis. Patients in the Western region had longer onset-to-first medical contact (FMC) time and time stay in non-PCI hospitals, lower rates of percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI) patients, and higher rates of medication usage. Patients in Central regions had relatively lower in-hospital mortality and in-hospital heart failure rates. Differences in the door-to-balloon time (DtoB) and in-hospital mortality between Western and Eastern regions were less after accreditation (β= -8.82, 95% confidence interval [CI] -14.61 to -3.03; OR=0.79, 95%CI 0.70 to 0.91). Similar results were found in differences in DtoB time, primary PCI rate for STEMI between Central and Eastern regions. The differences in PCI for higher-risk non-ST-segment elevation acute coronary syndrome (NSTE-ACS) patients among different regions had been smaller. Additionally, the differences in medication use between Eastern and Western regions were higher after accreditation. Regional variations remained high in this large cohort of patients with ACS from hospitals participating in the NCPCP in China. More comprehensive interventions and hospital internal system optimizations are needed to further reduce regional variations in the management and outcomes of patients with ACS.

DOI: 10.1016/j.scib.2024.03.010

Source: https://www.sciencedirect.com/science/article/abs/pii/S2095927324001543