中国急性冠状动脉综合征患者治疗和预后的地区差异:来自国家胸痛中心的证据

作     者：周书铎 张岩 董雪洁 马郡雄 李娜 史红 Sidney C.Smith Jr 金音子 许铭 向定成 郑志杰 霍勇 Shuduo Zhou;Yan Zhang;Xuejie Dong;Junxiong Ma;Na Li;Hong Shi;Sidney CSmith Jr;Yinzi Jin;Ming Xu;Dingcheng Xiang;Zhi-Jie Zheng;Yong Huo

作者机构：Department of Global HealthPeking University School of Public HealthBeijing 100191China Institute for Global Health and DevelopmentPeking UniversityBeijing100871China Department of CardiologyPeking University First HospitalBeijing 100034China Chinese Medical AssociationBeijing 100052China Division of Cardiovascular MedicineSchool of MedicineUniversity of North Carolina at Chapel HillNorth Carolina 27599-3140USA Department of CardiologyGeneral Hospital of Southern Theater Command of PLAGuangzhou 510010China 

出 版 物：《Science Bulletin》 (科学通报（英文版）)

年 卷 期：2024年第69卷第9期

页      面：1302-1312页

核心收录：

学科分类：0710[理学-生物学] 0831[工学-生物医学工程（可授工学、理学、医学学位）] 1007[医学-药学(可授医学、理学学位)] 100706[医学-药理学] 1002[医学-临床医学] 1001[医学-基础医学(可授医学、理学学位)] 0817[工学-化学工程与技术] 0804[工学-仪器科学与技术] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 0703[理学-化学] 0836[工学-生物工程] 10[医学] 

基　　金：supported by the 2020 China Medical Board(CMB) Competition Program (20-376) 

主　　题：Acute coronary syndromes Quality improvement Regional variations Quality metrics 

摘      要：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-percutaneous coronary intervention(PCI) hospitals, lower rates of PCI for ST-elevation myocardial infarction(STEMI) patients, and higher rates of medication *** in Central regions had relatively lower in-hospital mortality and in-hospital heart failure *** in the door-to-balloon time(Dto B) 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 Dto B 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 ***, 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.