急诊经皮冠状动脉介入治疗ST段抬高型心肌梗死患者症状开始时间至球囊扩张时间对预后的影响  

Prognostic implications of onset to balloon time on mortality in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention in real world experience

作　　者：赵霄潇 王莹 刘臣[1] 周鹏[1] 盛照雪 李健楠[1] 周金英[1] 陈润真 陈艺 宋莉[1] 赵汉军[1,2] 颜红兵[1,2] ZHAO Xiao-xiao;WANG Ying;LIU Chen;ZHOU Peng;SHENG Zhao-xue;LI Jian-nan;ZHOU Jin-ying;CHEN Run-zhen;CHEN Yi;SONG Li;ZHAO Han-jun;YAN Hong-bing(State Key Laboratory of Cardiovascular Disease,National Center for Cardiovascular Disease,Fuwai Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]国家心血管病中心北京协和医学院中国医学科学院阜外医院冠心病中心,北京100037 [2]国家心血管病中心中国医学科学院阜外医院深圳医院冠心病中心

出　　处：《中国介入心脏病学杂志》2020年第11期601-609,共9页Chinese Journal of Interventional Cardiology

基　　金：中国医学科学院医学与健康科技创新工程项目(2016-I2M-1-009)。

摘　　要：目的探讨对于行急诊经皮冠状动脉介入治疗(PCI)的ST段抬高型心肌梗死(STEMI)患者,从症状开始至球囊扩张(O-to-B)时间和死亡率之间的相关性。方法纳入自2010年1月至2018年7月中国医学科学院阜外医院行急诊PCI手术的STEMI患者的临床资料,符合入组和排除标准的共计3348例。结果在平均随访约3年的研究中,死亡人数共计192例(5.7%),有258例(7.7%)发生主要不良心血管事件(MACE),另有60例(1.8%)患者发生卒中事件。相关性研究表明,O-to-B时间与室壁瘤发病率(r=0.041,P=0.022)、心肌梗死溶栓治疗试验(TIMI)血流分级(r=0.110,P<0.001)、MACE发病率(r=0.046,P=0.010)和全因死亡率(r=0.061,P<0.001)呈显著正相关。受试者工作特征曲线(ROC)表明,与单纯的GRACE评分[曲线下面积(AUC)=0.681]相比,O-to-B时间联合GRACE评分作为共同预测因子,对死亡率的预测价值更高(AUC=0.699)。另外,随着O-to-B时间的延长,死亡率的累积发生率增加(P<0.05)。结论较短的O-to-B时间与行急诊PCI的STEMI患者良好的预后存在显著相关性。Objective The purpose of this study was to investigate the correlation between O-to-B and mortality in patients with ST-segment elevation myocardial infarction(STEMI)after primary percutaneous coronary intervention(PCI).Methods Clinical data of STEMI patients undergoing primary PCI at Fuwai Hospital,Chinese Academy of Medical Sciences from January 2010 to July 2018 were collected.A total of 3348 STEMI patients met the inclusion and exclusion criteria.Results A total of 192(5.7%)patients died and 258(7.7%)had a serious adverse cardiovascular event(MACE).60(1.8%)had a stroke event during the study with an media 3-year follow-up.Correlation studies showed that O-to-B time was signifi cantly positively correlated with the incidence of ventricular aneurysm(r=0.041,P=0.022),TIMI score(r=0.110,P<0.001),MACE incidence(r=0.046,P=0.010)and all-cause mortality(r=0.061,P<0.001).In addition,the survival receiver operating characteristic curve(ROC curve)showed that O-to-B time combined with GRACE score was a higher predictor of mortality than grace score alone(AUC=0.681)(AUC=0.699).In addition,the cumulative incidence of mortality increased with the extension of O-to-B time(log rank<0.05).Conclusions short O-to-B time was correlated with more optimized outcome in cases with STEMI undergoing primary PCI.

关 键 词：症状开始至球囊扩张时间 急诊经皮冠状动脉介入治疗 ST段抬高型心肌梗死 死亡率 

分 类 号：R541.4[医药卫生—心血管疾病]