急性心肌梗死再灌注时机对患者预后的影响  

Influence of percutaneous coronary intervention timing on the prognosis of patients with acute ST segment elevation myocardial infarction

作　　者：王军[1,2] 华琦[1] 李康[1] 王丽[1] 王云飞[1] 李小明[1] 薛淞[1] 江大川[1] 孔强[1] 胡少东[1] 张钰聪[1] 邵强[1] 刘马超[1] 赵霞[1] 王姗[1] 韩涛[1] 金蔚英[1] 王竞雄[1] 李静[1] 

机构地区：[1]首都医科大学宣武医院,北京100053 [2]北京市门头沟区医院

出　　处：《中国心血管杂志》2014年第6期413-417,共5页Chinese Journal of Cardiovascular Medicine

基　　金：国家自然科学基金项目(编号:81470491)~~

摘　　要：目的评价急性ST段抬高型心肌梗死（STEMI）患者接受直接经皮冠状动脉介入治疗时机对预后的影响。方法连续人选初发急性STEMI患者344例，按照急诊再灌注策略分为3组：未行急诊冠状动脉造影的患者110例为A组，发病至梗死相关血管开通时间在6h之内的118例为B组，超过6h而小于12h的116例为c组，对3组患者临床资料、住院期间心血管事件以及长期预后进行比较。结果A、B和C3组患者血糖分别为（8．4±4．7）mmol／L、（7．7±3．3）mmol／L和（7．7±4．6）mmoL／L（P=0．002）；血脂异常发生率分别为24．5％、5．9％和33．6％（P=0．008）；具有多重心血管危险因素（≥3个）的比例分别为25．5％、9．5％和43．1％（P=0．014）；冠状动脉单支病变（25．5％、46．9％和31．4％）、双支病变（33．6％、24．5％和33．3％）以及3支病变（40．9％、28．6％和35．3％）的比例差异有统计学意义（P=0．027）；住院期间主要不良心血管事件（MACE）发生率分别为12．7％、2．5％和12．9％（P=0．016）。经过36个月的随访，3组累积MACE发生率分别为20．9％、10．2％和23．3％（P=0．011）；Cox回归分析显示年龄、肌酐、入院时心率、前壁心肌梗死和发病至梗死相关血管开通时间〉6h（RR：2．268，95％CI：1．124—4．578，P=0．022）是MACE的独立危险因素。结论急性STEMI患者6h以后开通梗死相关血管未能改善远期预后，应该采取更有效的措施保证其发病6h内接受再灌注治疗。Objective To evaluate the influence of percutaneous coronary intervention （PCI） timing on prognosis of patients with acute ST segment elevation myocardial infarction （STEMI）. Methods A total of 344 patients with STEMI were divided into three groups according to the reperfusion strategies： group A： （no emergent PCI, n = 110） ,group B： （door to balloon time within 6 h after symptom onset, n = 118） and group C （door to balloon time within 6-12 h after symptom onset, n = 116）. Clinical outcomes were compared among three groups. Results There was significant difference in clinical characteristics among group A, B and C, including blood glucose [ （ 8.4 ± 4. 7 ） mmol/L, （7.7 ±3.3 ） mmol/L and （7.7 ±4. 6 ） mmol/L, respectively, P = O. 002 ], hyperlipldemia history （ 24. 5% , 5. 9% and 33.6% , respectively, P = O. 008 ）, ≥13 risk factors of cardiovascular disease （ 25.5%, 9.5% and 43.1%,respectively, P = 0. 014 ） and lesion number （ P = 0. 027 ） . In-hospital incidence of major adverse cardiovascular events （MACE） was 12. 7% in group A, 2. 5% in group B and 12. 9% in group C （P = 0. 016）. Cumulative incidence of MACE in three groups was 20.9% , 10. 2% and 23.3% （ P = O. 011 ） during tbllow up. In cox proportional hazards regression model, age, creatinine, heart rate, PCI time 〉 6 h （RR ：2. 268, 95 % CI： 1. 124-4. 578, P = O. 022 ） and anterior wall myocardial infarction were independent predictors for MACE during 36 months follow up. Conclusions In patients with STEM/, there is no obvious benefits from reopening of culprit artery 6 hours after symptom onset. Therefore, it is crucial to perform reperfusion therapy with 6 h.

关 键 词：心肌梗死 血管成形术 经腔 经皮冠状动脉 预后 

分 类 号：R542.22[医药卫生—心血管疾病]