急诊经皮冠状动脉介入术开通梗死相关血管时程变化对急性ST段抬高型心肌梗死早期预后的影响  

Impact of the time course of reperfusion on early outcomes in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

作　　者：徐广马[1] 胡昌兴[1] 林英忠[1] 刘伶[1] 覃绍明[1] 伍广伟[1] 林虹[1] 

机构地区：[1]广西壮族自治区人民医院心内科,南宁530021

出　　处：《临床心血管病杂志》2011年第8期600-602,共3页Journal of Clinical Cardiology

基　　金：广西壮族自治区卫生厅基金资助项目(No:Z2009168)

摘　　要：目的:观察急诊经皮冠状动脉介入术(PCI)开通梗死相关血管的时程变化对急性ST段抬高型心肌梗死(STEMI)住院期间死亡率及心肌梗死后30 d内心血管事件发生率的影响。方法:急性STEMI患者213例,根据症状发生至第1次球囊扩张的时间分为3组:<180 min组(A组,27例),180～360 min组(B组,83例),>360 min组(C组,103例)。观察各组术后30 d内主要心血管不良事件的发生率,包括心源性死亡、非致死性心肌梗死、急性亚急性支架内血栓形成。结果:症状发生到第1次球囊扩张的时间中位数为(355.3±223)min,C组老年患者(≥75岁)及女性患者相对多见,前壁梗死和心源性休克发生率较高。住院总心源性死亡率为13.6%,C组住院期间死亡率(17.5%)明显高于A组(3.7%)和B组(12.1%);急性心肌梗死的并发症心源性休克显著影响死亡率(36.5%)。随访30 d,心源性休克、≥75岁高龄、女性患者心血管事件发生率显著升高。多因素回归分析显示时间延迟>360 min是影响急性STEMI早期预后的独立危险因素。结论:急诊PCI时间的延迟显著影响急性STEMI早期预后。急诊PCI时间延迟超过6h是影响早期预后的独立危险因素。Objective：To observe the impact of treatment delays on early outcomes in patients with acute ST-segment elevation myocardial infarction（STEMI） undergoing primary percutaneous coronary intervention（pPCI）. Method：Two hundred and thirteen patients were stratified on the basis of their time delays： from symptom onset until balloon inflation.The patients were divided into 3 groups： group A（27 patients）-time from symptom onset ≤180 min;group B（83 patients）-time delays of 180-360 min;group C（103 patients）-time from symptom onset 360 min.During a 30-day follow-up,the major adverse cardiac event such as non-fatal reinfarction and cardiogenic shock and the cardiogenic mortality were recorded. Result：The median time delay was（355.3±223） min.The patients with longer time delays（groupC） were older,more often were women,and had a higher frequency of anterior MI and Killip class 4.During hospitalization 29（13.6%） patients died.In-hospital mortality was significantly higher in group C（17.5%） than in other groups.Complications of STEMI such as cardiogenic shock considerably influenced mortality（36.5%）.During a 30-day follow-up,the patients with cardiogenic shock and the elderly had an increased risk of cardiac events.Also,time delays 360 min was independent adverse risk factors in multivariate regression analysis. Conclusion：Time delays of pPCI have an important impact on early outcomes,especially in those treated 6 hours from the onset of symptoms.

关 键 词：经皮冠状动脉介入术 时程 心肌梗死 预后 

分 类 号：R654.3[医药卫生—外科学]