急性ST段抬高心肌梗死溶栓后早期介入治疗与直接介入治疗的对比研究  被引量:34

Early routine post-thrombolysis percutaneous coronary intervention vs. primary PCI in ST-segment elevated myocardial infarction: a comparative study

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作  者:万方[1] 张拓[1] 沈玲红[1] 卜军[1] 宋玮[1] 杜勇平[1] 金叔宣[1] 沈节艳[1] 何奔[1] 

机构地区:[1]上海交通大学医学院附属仁济医院,200127

出  处:《中国介入心脏病学杂志》2013年第1期3-7,共5页Chinese Journal of Interventional Cardiology

基  金:国家临床重点专科项目(2011);上海市领军人才项目(2012);上海市科委优秀学科带头人(XD1402600);上海市科委国际合作项目(12410708300)

摘  要:目的评估急性ST段抬高心肌梗死(STEMI)溶栓后早期经皮冠状动脉介入治疗(PCI)与直接PCI有效性及安全性的差异。方法纳入2010年1月至2011年12月期间在我中心行早期PCI及直接PCI治疗的急性STEMI患者,比较两组住院期间临床终点事件的发生率。采用多因素回归以及倾向积分法计算再灌注策略对临床终点事件的校正相对危险度(RR)。结果早期PCI组共纳入51例患者,直接PCI组共纳入159例患者。两组主要心血管不良事件发生率分别为:早期PCI组4.0%和直接PCI组5.7%(RR=0.647,95%CI:0.155~3.103)。多因素回归校正RR为0.663(95%CI:0.131~3.351),倾向积分法校正RR为0.316(95%CI:0.026~3.879)。安全性终点方面,两组TIMI出血发生率分别为早期PCI组4.0%和直接PCI组1.9%(RR=2.078,95%CI:0.357~12.095)。多因素回归校正RR为2.122(95%CI:0.345~13.070),倾向积分法校正RR为0.302(95%CI:0.010~9.228)。所有结果均未显示差异具有统计学意义。结论对于直接PCI可能延迟的STEMI患者,溶栓后早期PCI治疗是一种有效、安全的替代再灌注策略。Objective Compare the efficacy and safety of early routine post-thrombolysis percutaneous coronary intervention (early PCI) with primary percutaneous coronary interventionin (PPCI) for acute ST-segment elevated myocardial infarction (STEMI). Methods From January 2010 to December 2011, patients receiving early PCI or primary PCI in our center were screened and enrolled into this study. Incidences of in-hospital clinical events of two groups were compared. The risk ratios of efficacy and safety endpoints were adjusted by multivariable logistic regression and propensity score. Results 51 patients in early PCI group and 159 in PPCI group were finally included. The major cardio-cerebro vascular adverse event rates were 4. 0% in early PCI group and 5.7% in PPCI Group (RR =0. 647,95% confidence interval 95% CI:O. 155 - 3. 103 ). For safety endpoints, TIMI bleeding rates were 4. 0% in early PCI group and 1.9% in PPCI Group (RR =2. 078,95% CI:O. 357 - 12. 095). Multivariate logistic regression adjusted RR was 2. 122 (95% CI:O. 345 - 13. 070), the propensity score adjusted RR was 0. 302 (95% CI:O. 010 - 9. 228). Conclusions For patients with expected PCI-related delay, early routine post-thrombolysis PCI is a acceptable alternative reperfusion therapy strategy.

关 键 词:心肌梗死 血管成形术 经腔 经皮冠状动脉 因素分析 统计学 

分 类 号:R541.4[医药卫生—心血管疾病]

 

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