不同临床途径直接冠状动脉介入治疗对急性ST段抬高心肌梗死预后的影响  

Influence of different clinical pathways on prognosis of patients with ST-elevation myocardial infarction undergoing primary percutaneous coronary intervention

作　　者：葛智儒[1] 邱建平[1] 陆纪德[1] 张奇[2] 沈卫峰[2] 

机构地区：[1]上海市浦东新区公利医院心内科,上海200135 [2]上海交通大学医学院附属瑞金医院心脏科

出　　处：《临床心血管病杂志》2008年第12期912-915,共4页Journal of Clinical Cardiology

基　　金：上海市科委医学重大课题(No:05DZ19503)

摘　　要：目的:比较急诊室-导管室与急诊室-CCU(病房)-导管室这2种临床途径直接经皮冠状动脉介入治疗(PCI)对急性ST段抬高心肌梗死(STEMI)患者住院期和远期预后的影响。方法:分析12 h内接受直接PCI治疗的连续228例STEMI患者冠状动脉病变及干预情况,记录手术成功率、平均住院日、院内死亡率及随访期间终点事件发生率,并多因素回归分析心血管事件相关危险因素。结果:急诊室-导管室组(甲组)与急诊室-CCU-导管室组(乙组)临床特征、冠状动脉病变、PCI成功率及平均住院日相似。与乙组相比,甲组的就诊-球囊时间延迟缩短(P<0.01),住院期和随访期(32.3个月)死亡率及复合终点事件发生率显著减低(均P<0.05)。多因素回归分析表明,就诊-球囊时间(OR=1.01,P<0.05)和年龄(OR=1.06,P<0.05)与心血管事件发生率显著相关。结论:STEMI患者到达急诊室后,直接送导管室行PCI治疗可显著缩短就诊-球囊时间延迟,改善近期和远期临床预后。Objective： To evaluate the influence of different clinic pathways （emergency room-catheterization tanboratory, emergency room-CCU） on the hospitalization peniod and long term prognosis of patients with ST segment elevation myocardial infarction （STEMI） treated with primary percutaneous coronary intervention （PCI）. Method：This prospective randomized trial included 228 consecutive patients with STEMI treated with primary PCI within first 12 hours of symptom onset. Clinical and angiographic features, procedural success rate, average hospital stay, outcomes during hospitalization and follow-up were recorded. Multivariate regression analysis was performed to determine risk factors for major cardiac adverse events （MACE）. Result： Of them, 122 patients were transferred from emergency room directly to catheterization laboratory （Group I ）, and the remaining 106 patients were admitted to CCU or cardiac ward after they arrived at emergency room, and then transferred to catheteriza tion laboratory （Group Ⅱ ）. Clinical and coronary characteristics, procedural success rate and length of hospital stay were comparable between the two groups. Compared with Group Ⅱ , patients in Group I had shortened time delay from hospital arrival to balloon inflation （86 min vs 130 min, P〈0.01） and reduced in hospital mortality （1.64% vs 7.55%, P〈0.05）. During follow-up （average 32 months）, the occurrence rates of all-cause death （0. 820% vs 5.66%, P〈0.05） and composite MACE （8.20% vs 16.98%, P〈0.05） were significantly lower in Group Ⅰthan in Group Ⅱ. Multivariate analysis revealed that door to balloon time （OR= 1.01, P〈0.05） and age of patient （OR 1.06, P〈0.05） were the independent predictors for the occurrence of cardiovascular events. Conclusion：Clinical pathway of transferring patients with STEMI directly from emergency room to catheterization laboratory for primary PCI could reduce further door-to balloon time delay, and improve in-hospital and long-term progn

关 键 词：心肌梗死 经皮冠状动脉介入治疗 就诊-球囊时间 预后 

分 类 号：R542.2[医药卫生—心血管疾病]