Abstract: Background　Since 2014，Chengdu has continued to promote the construction of Chest Pain Center to improve the treatment of acute coronary syndrome（ACS）.At present，studies have reported a guideline-practice gap in the clinical diagnosis and treatment of patients with non-ST-segment elevation acute coronary syndrome（NSTE-ACS）.However，there is no research about the guideline-practice gap in the clinical diagnosis and treatment and its influencing factors in Chengdu.Objective　To explore the guideline-practice gap of NSTE-ACS treatment with the management of Chest Pain Center in Chengdu and analyze its influencing factors.Methods　 A multicenter retrospective cross-sectional study was conducted among 1 022 cases of NSTE-ACS receiving inpatient treatment in 11 hospitals with a well-constructed or under construction Chest Pain Center（7 with a primary level center） in Chengdu during 2017 to 2018.General information，treatment strategies，status of percutaneous coronary intervention（PCI）within the recommended time，and discharged medication of these patients were collected from the Chest Pain Center Data Reporting Platform and the electronic medical record system of these 11 hospitals.According to the risk criteria for invasive treatment strategies in the 2016 Chinese Guidelines for the Management of Non-ST-segment Elevation Acute Coronary Syndrome，the patients were divided into low-risk（141 cases ），medium-risk（178 cases），high-risk（668 cases），and extremely high-risk（35 cases） groups.Results　A total of 629（61.5%） cases underwent invasive diagnosis and treatment（388 underwent PCI）.The rate of receiving invasive diagnosis and treatment in low-risk group was higher than that in medium-risk group but was lower than that in high-risk group（P<0.05），and so was that in extremely high-risk group（P<0.05）.Binary Logistic regression analysis showed that NSTE-ACS type and history of coronary heart disease were influencing factors for undergoing PCI within the recommended time（P<0.05）.Compared with medium-risk group or extremely high-risk group，the rates of discharged with aspirin（ASA） and statins were lower in low-risk group but were higher in high-risk group（P<0.05）.The rates of discharged with P2Y12 inhibitors and dual antiplatelet therapy（DAPT）in extremely high-risk group were higher than those in low-risk or medium-risk group，but were lower than those in high-risk group（P<0.05）.The rate of discharged with beta-receptor blockers in medium-risk group was higher than that of low-risk group，and extremely high-risk group，but was lower than that of high-risk group（P<0.05）.The rates of discharged with angiotensin-converting enzyme inhibitors/angiotensin receptor blockers，and optimal medical therapy（OMT）in high-risk group were lower than those in low-risk group，meanwhile higher than those in middle-risk group and extremely high-risk group（P<0.05）.Binary Logistic regression analysis showed that diastolic blood pressure at admission and the level of Chest Pain Center were the influencing factors of OMT as discharge medication（P<0.05）.Conclusion　There are guideline-practice gaps in the invasive diagnosis and treatment rate（61.5%），PCI rate（38.0%），and secondary preventive medication P2Y12 inhibitor（74.0%），ASA（73.4%），and statins（86.7%）in NATE-ACS patients in Chengdu.Patients with unstable angina pectoris and without a history of coronary heart disease are not suggested to undergo PCI within the guideline-recommended time.Elevated diastolic blood pressure at admission and management by the primary Chest Pain Center are factors that promote patients discharged with OMT.

Key words: Acute coronary syndrome, Chest Pain Center, Guidebooks, Practice, Root cause analysis, Chengdu

摘要： 背景　自2014年以来，成都地区持续推动胸痛中心建设，以提高急性冠脉综合征（ACS）的救治水平。目前已有研究报道了非ST段抬高型急性冠脉综合征（NSTE-ACS）患者的临床诊疗存在指南-实践差距，但是尚无关于成都地区NSTE-ACS患者临床诊疗指南-实践差距及其原因分析的研究。目的　本研究为多中心回顾性横断面研究。探讨成都地区胸痛中心管理模式下NSTE-ACS治疗的指南-实践差距并分析其影响因素。方法　根据纳入与排除标准，最终选取成都地区正在建设和已经建设胸痛中心的三级医院共11家，纳入2017—2018年在这11家医院住院治疗的NSTE-ACS患者1 022例。在胸痛中心数据填报平台和11家医院（其中7家为基层版胸痛中心）的电子病历系统中收集NSTE-ACS患者一般资料、治疗策略、在推荐时间内行经皮冠状动脉介入治疗（PCI）情况及出院带药情况。根据《非ST段抬高型急性冠状动脉综合征诊断和治疗指南（2016）》中NSTE-ACS患者有创治疗策略风险标准对患者进行危险分层，分为低危（141例，低危组）、中危（178例，中危组）、高危（668例，高危组）和极高危（35例，极高危组）。结果　1 022例患者中，629例（61.5%）接受了侵入性诊疗（其中388例行PCI）。低危组、极高危组侵入性诊疗率高于中危组，低于高危组（P<0.05）。二元Logistic回归分析结果显示，NSTE-ACS类型、冠心病病史是患者在推荐时间内行PCI的影响因素（P<0.05）。中危组、极高危组出院带阿司匹林（ASA）、他汀类药物率高于低危组，低于高危组（P<0.05）；极高危组出院带P2Y12抑制剂、双联抗血小板治疗（DAPT）率高于低危组、中危组，低于高危组（P<0.05）；中危组出院带β-受体阻滞剂（BB）率高于低危组、极高危组，低于高危组（P<0.05）；高危组出院带血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（ACEI/ARB）、最佳药物治疗（OMT）率低于低危组，高于中危组、极高危组（P<0.05）。二元Logistic回归分析结果显示，入院舒张压和胸痛中心版本是出院带OMT的影响因素（P<0.05）。结论　成都地区NSTE-ACS患者侵入性诊疗率（61.5%）、PCI率（38.0%）和二级预防用药P2Y12抑制剂（74.0%）、ASA（73.4%）和他汀类药物（86.7%）均存在指南-实践差距；不稳定性心绞痛（UA）和无冠心病病史患者更不易在推荐时间内行PCI，而入院舒张压升高和基层版胸痛中心是促进患者出院带OMT的因素。

关键词: 急性冠状动脉综合征, 胸痛中心, 指南, 实践, 影响因素分析, 成都