Abstract: Background　Since the establishment of the first chest pain center in Tianjin in 2014，the mortality rate of acute myocardial infarction in Tianjin residents decreased for three consecutive years. Evaluating the significance of the construction of chest pain center may have important practical guidance for further establishment of high-quality and efficient healthcare delivery system. Objective　To compare the effect of acute ST-segment elevation myocardial infarction（STEMI） by different chest pain management models in Tianjin，providing suggestions for improving the construction of chest pain center，and offering evidence for the promotion of management model of chest pain center. Methods　From October 2014 to February 2019，8 011 STEMI patients who underwent emergency percutaneous coronary intervention（PCI） in 33 chest hospitals in Tianjin were selected. They were divided into groups A，B and C according to the chest pain management model in the hospital they visited：group A received the chest pain management without chest pain center certification（n=915），group B received the chest pain management with chest pain center certification（standard level）（n=6 981），and group C received the chest pain management with chest pain center certification（primary level）（n=115）. Symptom-to-door（S2D） time，symptom-to-first medical contact（S2FMC） time，first medical contact-to-ECG（FMC2ECG） time，first medical contact-to-balloon（FMC2B） time，and door-to-balloon（D2B） time were compared among three groups. Moreover，the prevalence rates of intensive 24-hour statins treatment，use of β-blockers，post-PCI TIMI grade 3 flow，and post-discharge combined use of drugs（dual antiplatelet drugs，statins，β-blockers，RAS blockers） were compared. Results　The median time of S2D，S2FMC，FMC2ECG，FMC2B and D2B in the participants were 117（147） min，100（128） min，2（2） min，76（47） min
and 67（32） min，respectively. There were significant differences in average median FMC2ECG time，FMC2B time，D2B time，as well as the prevalence rates of intensive 24-hour statins treatment，β-blocker use，post-PCI TIMI grade 3 flow，and post-discharge combined use of drugs among the three groups（P<0.05）. Further comparison showed that the prevalence rates of average median FMC2ECG time，FMC2B time，D2B time in group B were lower than those of group A（P<0.017），and post-PCI TIMI grade 3 flow in group B was higher than that of group A（P<0.017）；the prevalence rates of intensive 24-hour statins treatment，β-blocker use and post-discharge combined use of drugs in groups B and C were higher than those of group A（P<0.017）；Group C had lower average median FMC2ECG and D2B time and higher prevalence rate of intensive 24-hour statins treatment than group B（P<0.017）. From 2017 to 2019，the yearly median D2B time in group B was shorter than group A，and the prevalence rat of yearly median D2B time<90 min in group B was greater than group A. Conclusion　The standard chest pain management may significantly shorten the reperfusion time，standardize the clinical medication and improve the prognosis of acute STEMI patients，but the pre-hospital emergency time could not be shortened. It is necessary to continue to promote the construction of regional chest pain centers to save more patients.

Key words: Myocardial infarction；Angioplasty, balloon, coronary；Chest pain center

摘要： 背景　2014年天津市首家胸痛中心成立后，天津居民急性心肌梗死死亡率连续3年下降。对胸痛中心建设的效果进行评估，将对进一步建立优质高效医疗卫生服务体系具有重要的现实意义。目的　评估天津市胸痛中心模式下急性ST段抬高型心肌梗死（STEMI）患者的诊治情况，提出完善胸痛中心建设措施，为胸痛中心模式的推广提供决策依据。方法　选取2014年10月—2019年2月在天津市33家胸科医院行急诊经皮冠状动脉介入治疗（PCI）的STEMI患者8 011例为研究对象。根据患者就诊医院将其分为A、B、C组，A组为在未通过胸痛中心认证的胸科医院就诊的患者（n=915），B组为在通过胸痛中心认证（标准版）的胸科医院就诊的患者（n=6 981），C组为在通过胸痛中心认证（基层版）的胸科医院就诊的患者（n=115）。比较三组发病-到达本院大门（S2D）时间、发病-首次医疗接触（S2FMC）时间、首次医疗接触-首份心电图（FMC2ECG）时间、首次医疗接触-球囊扩张（FMC2B）时间、到达本院大门-球囊扩张（D2B）时间，以及24 h强化他汀治疗、β-受体阻滞剂使用、术后心肌梗死溶栓试验（TIMI）Ⅲ级血流、出院联合应用药物〔双联抗血小板药物、他汀、β-受体阻滞剂、肾素-血管紧张素系统（RAS）系统阻滞剂〕占比。结果　8 011例STEMI患者S2D中位时间为117（147） min，S2FMC中位时间为100（128） min，FMC2ECG中位时间为2（2） min，FMC2B中位时间为76（47） min，D2B中位时间为67（32） min。三组FMC2ECG时间、FMC2B时间、D2B时间，以及24 h强化他汀治疗、β-受体阻滞剂使用、术后TIMIⅢ级血流、出院联合应用药物占比比较，差异有统计学意义（P<0.05）。进一步两两比较显示，B组FMC2ECG时间、FMC2B时间、D2B时间低于A组，术后TIMIⅢ级血流占比高于A组（P<0.017）；B组和C组24 h强化他汀治疗、β-受体阻滞剂使用、出院联合应用药物占比均高于A组（P<0.017）；C组FMC2ECG时间、D2B时间低于B组，24 h强化他汀治疗占比高于B组（P<0.017）。2017—2019年，三组STEMI患者D2B时间排序为B组<A组，D2B时间<90 min占比排序为B组>A组。结论　天津市胸痛中心模式（标准版）可明显降低STEMI患者再灌注时间，规范STEMI患者临床用药并改善预后，但不能缩短院前急救时间，未来需继续推进区域胸痛中心的建设，挽救更多的患者。

关键词: 心肌梗死；血管成形术, 气囊, 冠状动脉；胸痛中心