Background:It remains unclear whether the outcomes of ST-elevation myocardial infarction(STEMI)patients treated with primary percutaneous coronary intervention(PPCI)during off-hours are as favorable as those treated d...Background:It remains unclear whether the outcomes of ST-elevation myocardial infarction(STEMI)patients treated with primary percutaneous coronary intervention(PPCI)during off-hours are as favorable as those treated during on-hours,especially those with a first medical contact-to-device(FMC-to-device)time within 90 min.We aimed to determine whether off-hours admission impacted late outcomes in patients undergoing PPCI and with an FMC-to-device time<90 min.Methods:This multicenter retrospective study included 670 STEMI patients who underwent successful PPCI and had an FMC-to-device time<90 min from 19 chest pain centers in Beijing from January 2018 to December 2018.Patients were divided into on-hours group and off-hours group based on their arrival time.Baseline characteristics,clinical data,and key time intervals during treatment were collected from the Quality Control&Improvement Center of Cardiovascular Intervention of Beijing by the 4tHeart and Brain Green Channel”app.Results:Overall,the median age of the patients was 58.8 years and 19.9%(133/670)were female.Of these,296(44.2%)patients underwent PPCI during on-hours and 374(55.8%)patients underwent PPCI during off-hours.Compared with the on-hours group,the off-hours group had a longer FMC-to-device time and fewer patients with FMC-to-device time<60 min(P<0.05).During the mean follow-up period of 24 months,a total of 64(9.6%)participants experienced a major adverse cardiovascular event(MACE),with 28(9.1%)in the on-hours group and 36(9.6%)in the off-hours group(P>0.05).According to the Cox regression analyses,off-hours admission was not a predictor of 2-year MACEs(P=0.788).Similarly,the Kaplan-Meier curves showed that the risks of a MACE,all-cause death,reinfarction,and target vessel revascularization were not significantly different between the two groups(P>0.05).Conclusions:This real-world,multicenter retrospective study demonstrated that for STEMI patients who underwent PPCI within 90 min,off-hours admission was safe,with no difference in the risk of 2-year MACEs compared with those with on-hours admission.展开更多
Objective To investigate whether admission time was associated with the delay of reperfusion therapy and in-hospital death in patients with ST-elevation myocardial infarction （STEMI）. Methods All patients with STEMI...Objective To investigate whether admission time was associated with the delay of reperfusion therapy and in-hospital death in patients with ST-elevation myocardial infarction （STEMI）. Methods All patients with STEMI who were admitted to the emergency depart- ment and underwent primary percutaneous coronary intervention at Peking University People＇s Hospital between April 2012 and March 2015 were included. We examined differences in clinical characteristics, total ischemic time, and in-hospital death between patients admitted during off-hours and those admitted during regular hours. Multivariate logistic regression was used to estimate the relationship between off-hours admission and clinical outcome. Results The sample comprised 184 and 105 patients with STEMI admitted to hospital during off-hours and regular hours, respectively. Total ischemic and onset-to-door times were significantly shorter in patients admitted during off-hours than among those admitted during regular hours （all P 〈 0.05）. Door-to-balloon （DTB） time, the rate of DTB time 〈 90 min, and in-hospital death were comparable between groups. Multivariate logistic regression showed that age and creatinine level, but not off-hours admission, were associated independently with increased in-hospital death. Conclusions Off-hours admission did not result in delayed reperfusion therapy or increased in-hospital mortality in patients with STEMI. Further efforts should focus on identifying pivotal factors associated with the pre-hospital and in-hospital delay of reperfusion therapy, and implementing quality improvement initiatives for reperfusion programs.展开更多
The stability and reliability of an ion source and its beam availability are extremely significant for any accelerator,especially for those high current long term CW operation ones like ADS. Although the first high qu...The stability and reliability of an ion source and its beam availability are extremely significant for any accelerator,especially for those high current long term CW operation ones like ADS. Although the first high quality 306-hours continuous wave（CW） operating curve at 50 m A@35 ke V has been successfully obtained with a standard compact 2.45 GHz ECR ion source at Peking University（PKU）, but the uncertainties that caused beam trips before are unacceptable during an accelerator real operation and should be eliminated. Meanwhile, no permission will be given when the beam power is upgraded from 50 m A@35 ke V to 50 m A@50 ke V. To improve the PKU CW proton source quality, several upgrades were done recently. After those improvements, a new long term CW proton beam experiment at 50 m A@50 ke V was carried out in June 2016. The total running time is 300.5 hours, including near 6 hours ion source preparation and 294 hours non-disturb continuous operation. Within the continuous 13 days operation, no beam-off happened, no spark was observed,no beam drop appeared, no interrupting action was needed, and only a few beam fluctuations caused by the air conditional failure occurred. Beam availability and reliability within the 294 hours is 100%. The root-mean-square（RMS） emittance of this 50 m A@50 ke V CW proton beam is about 0.186 π.mm.mrad. A careful inspection of the ion source was done after this long term operation and no obvious damage was found. The restart experimental results obtained after the ion source inspection prove the high repeatability of PKU PMECRIS. In addition, a 130-m A H＋beam was obtained at 50 k V with duty factor of 10%（100 Hz/1 ms） with this source. Details will be presented in this paper.展开更多
基金a grant from the National Natural Science Foundation of China(No.81670415).
文摘Background:It remains unclear whether the outcomes of ST-elevation myocardial infarction(STEMI)patients treated with primary percutaneous coronary intervention(PPCI)during off-hours are as favorable as those treated during on-hours,especially those with a first medical contact-to-device(FMC-to-device)time within 90 min.We aimed to determine whether off-hours admission impacted late outcomes in patients undergoing PPCI and with an FMC-to-device time<90 min.Methods:This multicenter retrospective study included 670 STEMI patients who underwent successful PPCI and had an FMC-to-device time<90 min from 19 chest pain centers in Beijing from January 2018 to December 2018.Patients were divided into on-hours group and off-hours group based on their arrival time.Baseline characteristics,clinical data,and key time intervals during treatment were collected from the Quality Control&Improvement Center of Cardiovascular Intervention of Beijing by the 4tHeart and Brain Green Channel”app.Results:Overall,the median age of the patients was 58.8 years and 19.9%(133/670)were female.Of these,296(44.2%)patients underwent PPCI during on-hours and 374(55.8%)patients underwent PPCI during off-hours.Compared with the on-hours group,the off-hours group had a longer FMC-to-device time and fewer patients with FMC-to-device time<60 min(P<0.05).During the mean follow-up period of 24 months,a total of 64(9.6%)participants experienced a major adverse cardiovascular event(MACE),with 28(9.1%)in the on-hours group and 36(9.6%)in the off-hours group(P>0.05).According to the Cox regression analyses,off-hours admission was not a predictor of 2-year MACEs(P=0.788).Similarly,the Kaplan-Meier curves showed that the risks of a MACE,all-cause death,reinfarction,and target vessel revascularization were not significantly different between the two groups(P>0.05).Conclusions:This real-world,multicenter retrospective study demonstrated that for STEMI patients who underwent PPCI within 90 min,off-hours admission was safe,with no difference in the risk of 2-year MACEs compared with those with on-hours admission.
文摘Objective To investigate whether admission time was associated with the delay of reperfusion therapy and in-hospital death in patients with ST-elevation myocardial infarction （STEMI）. Methods All patients with STEMI who were admitted to the emergency depart- ment and underwent primary percutaneous coronary intervention at Peking University People＇s Hospital between April 2012 and March 2015 were included. We examined differences in clinical characteristics, total ischemic time, and in-hospital death between patients admitted during off-hours and those admitted during regular hours. Multivariate logistic regression was used to estimate the relationship between off-hours admission and clinical outcome. Results The sample comprised 184 and 105 patients with STEMI admitted to hospital during off-hours and regular hours, respectively. Total ischemic and onset-to-door times were significantly shorter in patients admitted during off-hours than among those admitted during regular hours （all P 〈 0.05）. Door-to-balloon （DTB） time, the rate of DTB time 〈 90 min, and in-hospital death were comparable between groups. Multivariate logistic regression showed that age and creatinine level, but not off-hours admission, were associated independently with increased in-hospital death. Conclusions Off-hours admission did not result in delayed reperfusion therapy or increased in-hospital mortality in patients with STEMI. Further efforts should focus on identifying pivotal factors associated with the pre-hospital and in-hospital delay of reperfusion therapy, and implementing quality improvement initiatives for reperfusion programs.
文摘目的探讨非工作时间就诊对于急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STE⁃MI)患者接受经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)及院内病死率的影响。方法选取2017年1~12月北京清华长庚医院124例接受PCI治疗的急性STEMI患者,分别记录人口统计学资料、实验室检查和临床资料,以就诊时间分为工作时间组(就诊时间为工作日08:00至17:00)及非工作时间组(就诊时间为工作日17:00至次日08:00,周末和节假日),分析两组患者间心电图完成时间、心脏损伤标志物完成时间、门到球囊时间(door-to-balloon time,D to B时间)、急诊滞留时间及院内病死率。采用单因素logistic回归分析观察指标与就诊时间的关系。结果工作时间就诊47例(37.9%),非工作时间就诊77例(62.1%),冠脉造影结果显示两组的犯罪血管均主要为左前降支。非工作时间组在心电图完成时间([8.73±10.05)min比(7.53±6.87)min,P=0.47]、心肌特异性肌钙蛋白(cardiac isoform of Tropnin T,cTnT)完成时间([37.53±15.54)min比(33.13±14.89)min,P=0.12],D to B时间([90.19±37.43)min比(95.34±59.25)min,P=0.55]和急诊滞留时间([51.66±32.21)min比(54.04±54.73)min,P=0.76]方面与工作时间组比较,差异均无统计学意义。将所有基线数据及D to B时间纳入对于就诊时间的logistic回归分析,发现均与就诊时间无相关性。结论非工作时间就诊的STEMI患者在接受心电图、心脏损伤标志物检测及PCI治疗方面无延误,院内病死率同工作时间就诊的患者并无差异。
基金Project supported by the National Basic Research Program of China(Grant No.2014CB845502)the National Natural Science Foundation of China(Grant No.11575013)
文摘The stability and reliability of an ion source and its beam availability are extremely significant for any accelerator,especially for those high current long term CW operation ones like ADS. Although the first high quality 306-hours continuous wave（CW） operating curve at 50 m A@35 ke V has been successfully obtained with a standard compact 2.45 GHz ECR ion source at Peking University（PKU）, but the uncertainties that caused beam trips before are unacceptable during an accelerator real operation and should be eliminated. Meanwhile, no permission will be given when the beam power is upgraded from 50 m A@35 ke V to 50 m A@50 ke V. To improve the PKU CW proton source quality, several upgrades were done recently. After those improvements, a new long term CW proton beam experiment at 50 m A@50 ke V was carried out in June 2016. The total running time is 300.5 hours, including near 6 hours ion source preparation and 294 hours non-disturb continuous operation. Within the continuous 13 days operation, no beam-off happened, no spark was observed,no beam drop appeared, no interrupting action was needed, and only a few beam fluctuations caused by the air conditional failure occurred. Beam availability and reliability within the 294 hours is 100%. The root-mean-square（RMS） emittance of this 50 m A@50 ke V CW proton beam is about 0.186 π.mm.mrad. A careful inspection of the ion source was done after this long term operation and no obvious damage was found. The restart experimental results obtained after the ion source inspection prove the high repeatability of PKU PMECRIS. In addition, a 130-m A H＋beam was obtained at 50 k V with duty factor of 10%（100 Hz/1 ms） with this source. Details will be presented in this paper.
