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胸痛センター認定が急性大動脈解離の病院アウトカムに与える効果：中国における全国的研究

  • role： Contribute equally, First author同等贡献者, 第一作者
  • Affiliation：

    Department of Cardiology, Zhongshan Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China

    Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China

    State Key Laboratory of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China

    Key Laboratory of Viral Heart Diseases, National Health Commission, Shanghai 200032, China

Li-Wei Liu1234,  
  • role： Contribute equally同等贡献者
  • Affiliation：

    Department of Cardiology, Zhongshan Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China

    Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China

    State Key Laboratory of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China

    Key Laboratory of Viral Heart Diseases, National Health Commission, Shanghai 200032, China

Yi-Kai Cui1234,  
  • role： Contribute equally同等贡献者
  • Affiliation：

    Department of Emergency and Critical Care Medicine, Jinshan Hospital of Fudan University, Shanghai 201508, China

Lin Zhang5,  
  • role： Contribute equally同等贡献者
  • Affiliation：

    Department of Cardiology, Zhongshan Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China

    Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China

    State Key Laboratory of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China

    Key Laboratory of Viral Heart Diseases, National Health Commission, Shanghai 200032, China

Dai-Le Jia1234,  
  • role： Contribute equally同等贡献者
  • Affiliation：

    Reproductive Medicine Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China

Jing Wang6,  
  • Affiliation：

    Department of Cardiac Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China

Jia-Wei Gu7,  
  • Affiliation：

    Department of Cardiology, Zhongshan Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China

    Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China

    State Key Laboratory of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China

    Key Laboratory of Viral Heart Diseases, National Health Commission, Shanghai 200032, China

Jin-Yan Zhang1234,  
  • Affiliation：

    Department of Cardiology, Zhongshan Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China

    Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China

    State Key Laboratory of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China

    Key Laboratory of Viral Heart Diseases, National Health Commission, Shanghai 200032, China

Zhen Dong1234,  
  • Affiliation：

    Department of Cardiology, Zhongshan Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China

    Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China

Xue-Juan Jin12,  
  • Affiliation：

    Reproductive Medicine Center, Zhongshan Hospital, Fudan University, Shanghai 200032, China

Xiao-Yi Zou6,  
  • Affiliation：

    Department of Cardiology, Copenhagen University Hospital, 2100 Copenhagen, Denmark

Guo-Li Sun8,  
  • Affiliation：

    Department of Cardiology, Zhongshan Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China

    Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China

    State Key Laboratory of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China

    Key Laboratory of Viral Heart Diseases, National Health Commission, Shanghai 200032, China

Yu-Xiang Dai1234,  
  • role： Corresponding author通信作者
  • Affiliation：

    Department of Cardiology, Zhongshan Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China

    Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China

    State Key Laboratory of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China

    Key Laboratory of Viral Heart Diseases, National Health Commission, Shanghai 200032, China

  • Email：sun.aijun@zshospital.sh.cn
  • Introduction：* sun.aijun@zshospital.sh.cn
Ai-Jun Sun1234*,  
  • role： Corresponding author通信作者
  • Affiliation：

    Department of Cardiology, Zhongshan Hospital, Institutes of Biomedical Sciences, Fudan University, Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China

    Institutes of Biomedical Sciences, Fudan University, Shanghai 200032, China

    State Key Laboratory of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China

    Key Laboratory of Viral Heart Diseases, National Health Commission, Shanghai 200032, China

  • Email：jbge@zs-hospital.sh.cn
  • Introduction：jbge@zs-hospital.sh.cn
Jun-Bo Ge1234*

サマリー

Background:The National Chest Pain Center Program (NCPCP) is a nationwide, quality enhancement program aimed at raising the standard of care for patients experiencing acute chest pain in China. The benefits of chest pain center (CPC) accreditation on acute coronary syndrome have been demonstrated. However, there is no evidence to indicate whether CPC accreditation improves outcomes for patients with acute aortic dissection (AAD).Methods:We conducted a retrospective observational study of patients with AAD from 1671 hospitals in China, using data from the NCPCP spanning the period from January 1, 2016 to December 31, 2022. The patients were divided into 2 groups: pre-accreditation and post-accreditation admissions. The outcomes examined included in-hospital mortality, misdiagnosis, and Stanford type A AAD surgery. Multivariate logistic regression was employed to explore the relationship between CPC accreditation and in-hospital outcomes. Furthermore, we stratified the hospitals based on their geographical location (Eastern/Central/Western regions) or administrative status (provincial/non-provincial capital areas) to assess the impact of CPC accreditation on AAD patients across various regions.Results:The analysis encompassed a total of 40,848 patients diagnosed with AAD. The post-accreditation group exhibited significantly lower rates of in-hospital mortality and misdiagnosis (12.1% vs. 16.3%, P<0.001 and 2.9% vs. 5.4%, P<0.001, respectively) as well as a notably higher rate of Stanford type A AAD surgery (61.1% vs. 42.1%, P<0.001) compared with the pre-accreditation group. After adjusting for potential covariates, CPC accreditation was associated with substantially reduced risks of in-hospital mortality (adjusted OR=0.644, 95% CI 0.599–0.693) and misdiagnosis (adjusted OR=0.554, 95% CI 0.493–0.624), along with an increase in the proportion of patients undergoing Stanford type A AAD surgery (adjusted OR=1.973, 95% CI 1.797–2.165). Following CPC accreditation, there were significant reductions in in-hospital mortality across various regions, particularly in Western regions (from 21.5% to 14.1%). Moreover, CPC accreditation demonstrated a more pronounced impact on in-hospital mortality in non-provincial cities compared to provincial cities (adjusted OR: 0.607 vs. 0.713).Conclusion:CPC accreditation is correlated with improved management and in-hospital outcomes for patients with AAD.

キーワード

Acute aortic dissection (AAD);Chest pain center (CPC);Accreditation;In-hospital outcomes

References

  1. 1..
    Murphy SL, Xu J, Kochanek KD, Arias E, Tejada-Vera B. Deaths: final data for 2018. Natl Vital Stat Rep. 2021;69(13):1–83.
  2. 2..
    Wang SW, Huang YB, Huang JW, Chiu CC, Lai WT, Chen CY. Epidemiology, clinical features, and prescribing patterns of aortic aneurysm in Asian population from 2005 to 2011. Medicine (Baltimore). 2015;94(41):e1716.
  3. 3..
    Bossone E, Corteville DC, Harris KM, Suzuki T, Fattori R, Hutchison S, et al. Stroke and outcomes in patients with acute type a aortic dissection. Circulation. 2013;128(11 Suppl 1):S175–9.
  4. 4..
    Benjamin EJ, Blaha MJ, Chiuve SE, Cushman M, Das SR, Deo R, et al. Heart disease and stroke statistics-2017 update: a report from the American heart association. Circulation. 2017;135(10):e146-603.
  5. 5..
    Carrel T, 3rdSundt TM, von Kodolitsch Y, Czerny M. Acute aortic dissection. Lancet. 2023;401(10378):773–88.
  6. 6..
    Guo MH, Appoo JJ, Saczkowski R, Smith HN, Ouzounian M, Gregory AJ, et al. Association of mortality and acute aortic events with ascending aortic aneurysm: a systematic review and meta-analysis. JAMA Netw Open. 2018;1(4):e181281.
  7. 7..
    Martin C, Martin G, Tim B, Victor A, Alessandro Della C, Edward PC, et al. EACTS/STS Guidelines for diagnosing and treating acute and chronic syndromes of the aortic organ. Eur J Cardio-Thoracic Surg. 2024;65:ezad426.
  8. 8..
    Eikelboom R, Katz N. Acute aortic dissection presenting as status epilepticus. CMAJ. 2020;192(11):E283–5.
  9. 9..
    Olin JW, Fuster V. Acute aortic dissection: the need for rapid, accurate, and readily available diagnostic strategies. Arterioscler Thromb Vasc Biol. 2003;23(10):1721–3.
  10. 10..
    Ohle R, Kareemi HK, Wells G, Perry JJ. Clinical examination for acute aortic dissection: a systematic review and meta-analysis. Acad Emerg Med. 2018;25(4):397–412.
  11. 11..
    Bazarian JJ, Bennett RS. Chest pain and aortic dissection. Ann Emerg Med. 1995;26(4):526–7.
  12. 12..
    Yin J, Liu F, Wang J, Yuan P, Wang S, Guo W. Aortic dissection: global epidemiology. Cardiol Plus. 2022;7:151–61.
  13. 13..
    Shuduo Z, Yan Z, Xuejie D, Junxiong M, Na L, Hong S, et al. Regional variations in management and outcomes of patients with acute coronary syndrome in China: evidence from the National Chest Pain Center Program. Sci Bull. 2024;69:1302–12.
  14. 14..
    Evangelista A, Isselbacher EM, Bossone E, Gleason TG, Eusanio MD, Sechtem U, et al. Insights from the international registry of acute aortic dissection: a 20-year experience of collaborative clinical research. Circulation. 2018;137(17):1846–60.
  15. 15..
    Blankenship JC, Almquist AK. Cardiovascular complications of thrombolytic therapy in patients with a mistaken diagnosis of acute myocardial infarction. J Am Coll Cardiol. 1989;14(6):1579–82.
  16. 16..
    Wilcox RG, von der Lippe G, Olsson CG, Jensen G, Skene AM, Hampton JR. Trial of tissue plasminogen activator for mortality reduction in acute myocardial infarction: Anglo-Scandinavian Study of Early Thrombolysis (ASSET). Lancet. 1988;2(8610):525–30.
  17. 17..
    Sun P, Li J, Fang W, Su X, Yu B, Wang Y, et al. Effectiveness of chest pain centre accreditation on the management of acute coronary syndrome: a retrospective study using a national database. BMJ Qual Saf. 2021;30(11):867–75.
  18. 18..
    Ross MA, Amsterdam E, Peacock WF, Graff L, Fesmire F, Garvey JL, et al. Chest pain center accreditation is associated with better performance of centers for medicare and medicaid services core measures for acute myocardial infarction. Am J Cardiol. 2008;102(2):120–4.
  19. 19..
    Gibler WB, Runyon JP, Levy RC, Sayre MR, Kacich R, Hattemer CR, et al. A rapid diagnostic and treatment center for patients with chest pain in the emergency department. Ann Emerg Med. 1995;25(1):1–8.
  20. 20..
    Bahr RD. Chest pain centers: moving toward proactive acute coronary care. Int J Cardiol. 2000;72(2):101–10.
  21. 21..
    Bahr RD, Copeland C, Strong J. Chest pain centers–part 2: the strategy of the chest pain center. J Cardiovasc Manag. 2002;13(2):21–2.
  22. 22..
    Xiang D, Jin Y, Fang W, Su X, Yu B, Wang Y, et al. The national chest pain centers program: monitoring and improving quality of care for patients with acute chest pain in China. Cardiol Plus. 2021;6:187–97.
  23. 23..
    Fan F, Li Y, Zhang Y, Li J, Liu J, Hao Y, et al. Chest pain center accreditation is associated with improved in-hospital outcomes of acute myocardial infarction patients in China: Findings from the CCC-ACS project. J Am Heart Assoc. 2019;8(21):e013384.
  24. 24..
    Liu Q, Guo Y. Regional differences of individual and allocation efficiencies of health resources in China. Front Public Health. 2023;11:1306148.
  25. 25..
    Bossone E, Gorla R, LaBounty TM, Suzuki T, Gilon D, Strauss C, et al. Presenting systolic blood pressure and outcomes in patients with acute aortic dissection. J Am Coll Cardiol. 2018;71(13):1432–40.
  26. 26..
    Tolenaar JL, Froehlich W, Jonker FH, JrUpchurch GR, Rampoldi V, Tsai TT, et al. Predicting in-hospital mortality in acute type b aortic dissection: evidence from international registry of acute aortic dissection. Circulation. 2014;130(11 Suppl 1):S45-50.
  27. 27..
    Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, et al. 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014;35(41):2873–926.
  28. 28..
    Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, et al. The international registry of acute aortic dissection (IRAD): new insights into an old disease. JAMA. 2000;283(7):897–903.
  29. 29..
    Butler J, Davies AH, Westaby S. Streptokinase in acute aortic dissection. BMJ. 1990;300(6723):517–9.
  30. 30..
    Dong X, Ding F, Zhou S, Ma J, Li N, Maimaitiming M, et al. Optimizing an emergency medical dispatch system to improve prehospital diagnosis and treatment of acute coronary syndrome: nationwide retrospective study in China. J Med Internet Res. 2022;24(11):e36929.
  31. 31..
    Golden AP, Odoi A. Emergency medical services transport delays for suspected stroke and myocardial infarction patients. BMC Emerg Med. 2015;15:34.
  32. 32..
    Nienaber CA, Clough RE, Sakalihasan N, Suzuki T, Gibbs R, Mussa F, et al. Aortic dissection. Nat Rev Dis Primers. 2016;2:16053.
  33. 33..
    van Arsdell GS, David TE, Butany J. Autopsies in acute type A aortic dissection. Surgical implications. Circulation. 1998;98(19 Suppl):299–302 (discussion II-4).
  34. 34..
    Higo Y, Sawayama Y, Takashima N, Harada A, Yano Y, Yamamoto T, et al. Epidemiology of acute aortic dissection in a general population of 1.4 million people in Japan - Shiga Stroke and heart attack registry. Circ J. 2023;87(9):1155–61.
  35. 35..
    Kanaoka K, Iwanaga Y, Nakai M, Sumita Y, Saito Y, Miyamoto Y. Temporal trends and regional variations in cardiovascular care in Japan, 2010–2019. Int Heart J. 2023;64(1):53–9.
  36. 36..
    Jacobs JW, Shih AW, Lombard FW, Bartoszko J, Mullane D, Cserti-Gadzewich C, et al. A multidisciplinary comparison of transfusion and perioperative support for high-risk cardiac surgery at three large academic centres in North America. Transfus Med. 2023;33(4):337–48.
  37. 37..
    Tanaka A, Hebert AM, Smith-Washington A, Hoffstaetter T, Goldenberg R, Vemulapalli S, et al. Knowledge gaps in surgical management for aortic dissection. Semin Vasc Surg. 2022;35(1):35–42.
  38. 38..
    Huckaby LV, Sultan I, Trimarchi S, Leshnower B, Chen EP, Brinster DR, et al. Sex-based aortic dissection outcomes from the international registry of acute aortic dissection. Ann Thoracic Surg. 2022;113:498–505.

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