新型冠状病毒感染对北京市STEMI患者行PPCI的影响  

Impact of COVID-19 on primary percutaneous coronary intervention in patients with acute ST segment elevation myocardial infarction in Beijing

作　　者：李静[1] 孙璟皓 李晓洁 刘颖 俞梦越[2] 李冬梅 马艺欣 罗鸿宇[1] 杨跃进[2] Li Jing;Sun Jinghao;Li Xiaojie;Liu Ying;Yu Mengyue;Li Dongmei;Ma Yixin;Luo Hongyu;Yang Yuejin(Department of Geriatrics,Xuanwu Hospital Capital Medical University,National Clinical Research Center for Geriatric Diseases,Beijing 100053,China;Quality Control and Improvement Center of Cardiovascular Intervention in Beijing,Fuwai Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100037,China;Department of Science and Education,Beijing Municipal Health Commission,Beijing 100053,China;Beijing Anlong Maide Medical Technology Co.,Ltd,Beijing 100085,China)

机构地区：[1]首都医科大学宣武医院老年医学科、国家老年疾病临床医学研究中心,北京100053 [2]中国医学科学院北京协和医学院阜外医院、北京市心血管介入质量控制和改进中心,北京100037 [3]北京市卫生健康委员会科教处,北京100053 [4]北京安龙脉德医学科技有限公司,北京100085

出　　处：《中华心血管病杂志》2023年第9期977-983,共7页Chinese Journal of Cardiology

基　　金：北京市科技计划(Z191100006619108);国家自然科学基金(82170347)。

摘　　要：目的研究新型冠状病毒感染对北京市急性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(PPCI)的影响。方法本研究为多中心回顾性研究。纳入2019年1月1日至2021年12月31日心脑绿色通道APP中所有接受PPCI的STEMI患者。分别收集2019、2020和2021年患者临床资料及STEMI诊疗时间指标[包括发病至首次医疗接触时间(S-FMC)、发病至医院就诊时间(StoD)、首次医疗接触至首份心电图时间(FMC-ECG)、首次医疗接触至导丝通过时间(FMC-W)、进门至球囊扩张时间(DtoB)和总缺血时间]。将年龄<60岁的STEMI患者作为中青年组,年龄≥60岁的STEMI患者作为老年组进行亚组分析。结果最终纳入接受PPCI的STEMI患者7435例,其中男性5990例,年龄(59.6±12.6)岁。2019、2020和2021年分别有3305、1796和2334例。2019、2020、2021年接受PPCI的STEMI患者的FMC-ECG分别为3(1,5)min、3(1,7)min、4(1,7)min,FMC-W分别为73(56,87)min、78(62,95)min、77(62,87)min,DtoB分别为73(56,85)min、78(62,95)min、77(62,86)min,总缺血时间分别为189(130,273)min、196(138,295)min、209(143,276)min,2020和2021年就诊患者的FMC-ECG、FMC-W、DtoB和总缺血时间均长于2019年(P均<0.05)。2020年就诊患者中FMC-ECG≤10 min[88.4%(1588/1796)比92.7%(3064/3305),P<0.05]、FMC-W≤120 min[87.9%(1579/1796)比91.7%(3030/3305),P<0.05]、DtoB≤90 min者占比[72.3%(1298/1796)比80.8%(2672/3305),P<0.05]均低于2019年,而2021年与2019年比较FMC-ECG≤10 min[91.3%(2131/2334)比92.7%(3064/3305),P=0.054]、FMC-W≤120 min[92.0%(2148/2334)比91.7%(3030/3305),P=0.635]、DtoB≤90 min者占比[80.0%(1867/2334)比80.8%(2672/3305),P=0.424]差异均无统计学意义。亚组分析结果显示,2019年老年组中FMC-ECG≤10 min、FMC-W≤120 min、DtoB≤90 min者占比均低于中青年组,2021年老年组中FMC-W≤120 min、DtoB≤90 min者占比均低于中青年组(P均<0.05),而2020年两组FMC-ECG≤10 min、FMC-W≤120 min、DtoB≤90 min者比例差异均无�ObjectiveTo investigate the impact of COVID-19 on treatment of patients with acute ST segment elevation myocardial infarction(STEMI)undergoing primary percutaneous coronary intervention(PPCI).MethodsThis was a multicenter retrospective study.STEMI patients undergoing PPCI from January 1,2019 to December 31,2021 were selected,based on the data of Xinnaolvsetongdao App.Clinical data and treatment time indicators,including symptom to first medical contact(S-FMC),symptom to door(StoD),first medical contact to ECG(FMC-ECG),first medical contact to guide wire(FMC-W),door to balloon(DtoB)and total ischemic time in 2019,2020 and 2021 were compared.STEMI patients aged<60 years were sub-grouped as the young and middle-aged group,and STEMI patients aged≥60 years were sub-grouped as the elderly group.ResultsA total of 7435(3305 in 2019,1796 in 2020 and 2334 in 2021)STEMI patients aged(59.6±12.6)years undergoing PPCI were included in this analysis.There were 5990 males.For STEMI patients with PPCI in 2019,2020 and 2021,FMC-ECG was 3(1,5)min,3(1,7)min and 4(1,7)min.FMC-W was 73(56,87)min,78(62,95)min and 77(62,87)min.DtoB was 73(56,85)min,78(62,95)min and 77(62,86)min.Total ischemic time was 189(130,273)min,196(138,295)min and 209(143,276)min.FMC-ECG,FMC-W,DtoB and total ischemic time were longer in 2020 and 2021 than in 2019(all P<0.05).The proportions of patients with FMC-ECG≤10 min(88.4%(1588/1796)vs.92.7%(3064/3305),P<0.05),FMC-W≤120 min(87.9%(1579/1796)vs.91.7%(3030/3305),P<0.05)and DtoB≤90 min(72.3%(1298/1796)vs.80.8%(2672/3305),P<0.05)were lower in 2020 than in 2019,whereas no differences were observed in the proportions of patients with FMC-ECG≤10 min(91.3%(2131/2334)vs.92.7%(3064/3305),P=0.054),FMC-W≤120 min(92.0%(2148/2334)vs.91.7%(3030/3305),P=0.635)and DtoB≤90 min(80.0%(1867/2334)vs.80.8%(2672/3305),P=0.424)in 2021 compared with 2019.In the subgroup analysis,the proportions of patients with FMC-ECG≤10 min,FMC-W≤120 min and DtoB≤90 min were lower in the elderly group than in young and middle-age

关 键 词：心肌梗死 新型冠状病毒 直接经皮冠状动脉介入治疗 年龄 心脑绿色通道APP 

分 类 号：R563.1[医药卫生—呼吸系统] R542.22[医药卫生—内科学]