Enhanced prognosis and regional cooperative rescue systems for acute myocardial infarction: insights from chest pain centers in Ningxia, China

Abstract

Chest Pain Centers (CPC) demonstrated improved outcomes for patients with acute myocardial infarction (AMI) globally. However, the long-term impact of CPC establishment in economically developing areas, such as Ningxia, China, remains unclear. This study aimed to assess the long-term prognosis and efficacy of collaborative regional rescue systems centered on CPC for ST-segment elevation myocardial infarction (STEMI) patients in Ningxia. This retrospective cohort study analyzed 5344 STEMI patients from the Ningxia Myocardial Infarction Registry (2014-2019). Based on CPC establishment, patients were segregated into two groups: pre-CPC (n = 2141) and post-CPC (n = 3203). Kaplan-Meier survival analysis and Cox proportional hazards models were employed to compare the groups and evaluate long-term outcomes, including mortality and major adverse cardiovascular and cerebrovascular events (MACCEs). A total of 5344 acute STEMI patients were included, with 2141 (40.06%) in the pre-CPC group and 3203 (59.94%) in the post-CPC group. In comparison to the pre-CPC group, the post-CPC group exhibited lower all-cause mortality rates at 30 days (4.53% vs. 6.68%, p = 0.001), 1 year (6.24% vs. 9.11%, p = 0.001), and 3 years (8.55% vs. 11.86%, p < 0.001). Additionally, the post-CPC group showed decreased rates of MACCEs at 30 days (7.90% vs. 10.00%, p = 0.008) and 3 years (18.86% vs. 23.12%, p < 0.001). Kaplan-Meier survival analysis yielded similar results. After adjusting for confounding factors using COX multivariable regression, the CPC establishment was found to be a protective factor for all-cause mortality and MACCEs within 30 days (MACCEs: HR = 0.72, 95%CI 0.59-0.88, p = 0.005; all-cause mortality: HR = 0.59, 95%CI 0.46-0.77, p < 0.001), 1 year (MACCEs events: HR = 0.80, 95%CI 0.68-0.94, p = 0.006; all-cause mortality: HR = 0.59, 95%CI 0.44-0.69, p < 0.001), and 3 years (MACCEs: HR = 0.71, 95%CI 0.62-0.81, p < 0.001; all-cause mortality: HR = 0.55, 95%CI 0.46-0.67, p < 0.001). The establishment of Chest Pain Centers and implementation of regional cooperative rescue systems significantly improved the long-term prognosis of STEMI patients in Ningxia. These findings underscore the importance of developing CPC in underdeveloped regions to enhance cardiovascular emergency care and reduce mortality and morbidity associated with acute myocardial infarction.

Keywords: Acute ST-segment elevation myocardial infarction; Chest pain center; Prognosis; Reperfusion therapy.

Fig. 1

The flow chart of research subject. CPC chest pain center, AMI acute myocardial infarction, STEMI ST-segment elevated myocardial infarction, NSTEMI non- ST-segment elevated myocardial infarction

Fig. 2

Cumulative Kaplan–Meier curve estimates of outcomes. Data for MACCE (A) and all-cause death (B) within 30 days; Data for MACCE (C) and all-cause death (D) within 1 year; Data for MACCE (E) and all-cause death (F) within 3 year. MACCE major adverse cardiovascular and cerebrovascular events

Fig. 3

Outcomes within 30 Days, 1 years and 3 years After Onset Associated with CPC Establishment: Unadjusted and Multivariate Adjusted Analyses*. *Model 1 was unadjusted. Model 2: adjusted for age, sex and BMI. Model 3: adjusted age, sex, BMI, diabetes, hypertension, cerebrovascular disease, peripheral vascular disease, atrial fibrillation, chronic obstructive pulmonary, gastrointestinal ulcer history. Model 4: adjusted age, sex, BMI, diabetes, hypertension, cerebrovascular disease, peripheral vascular disease, atrial fibrillation, chronic obstructive pulmonary, gastrointestinal ulcer history, Troponin-T, RBC, Platelet, Albumin, Creatinine, Sodium, Chlorine, Uric acid, ALT, CK, LDL cholesterol, HDL cholesterol, Triglycerides, SBP at admission, DBP at admission, Multivessel disease, Killip classification and No-reflow. CPC chest pain centers, MACCE major adverse cardiovascular and cerebrovascular events