急诊PCI与延迟PCI对高血栓负荷STEMI患者预后的影响  

The Impact of Emergency PCI and Delayed PCI on the Prognosis of STEMI Patients with High Thrombotic Burden

作　　者：杜晶[1] 冯琴 黄春[1] DU Jing;FENG Qin;HUANG Chun(Departmen of Cardiovascular,the First Division Hospital of Xinjiang Production and Construction Corps,Aksu843000,Xinjiang Uygur Autonomous Region,China;Department of Endocrinology,the First Division Hospital ofXinjiang Production and Construction Corps,Aksu 843000,Xinjiang Uygur Autonomous Region,China)

机构地区：[1]新疆生产建设兵团第一师医院心血管内科,新疆维吾尔自治区阿克苏843000 [2]新疆生产建设兵团第一师医院内分泌科,新疆维吾尔自治区阿克苏843000

出　　处：《系统医学》2024年第20期89-92,共4页Systems Medicine

基　　金：第一师阿拉尔市科技计划项目(2022YL08)。

摘　　要：目的探讨和分析急诊经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)及延迟PCI对高血栓负荷急性ST段抬高型心肌梗死(ST-elevated myocardial infarction,STEMI)患者预后的影响。方法非随机选取2022年1月—2023年12月在新疆兵团第一师医院住院治疗的高血栓负荷STEMI达到TIMI3级的192例患者为研究对象,根据支架置入时间分为急诊PCI组(n=64)与延迟PCI组(n=128),急诊PCI组患者实施PCI手术,延迟PCI组患者7~14 d后实施PCI手术,比较两组纽约心脏病协会分级、心功能指标、并发症情况及远期预后。结果延迟PCI组术后30、90、180 d的心功能分级均优于急诊PCI组,差异有统计学意义(P均<0.05)。与急诊PCI组相比,延迟PCI组患者STEMI发生后30、90、180 d左心室射血分数水平更高,左室舒张末期内径及脑尿钠肽水平更低,差异有统计学意义(P均<0.05)。延迟PCI组并发症总发生率为3.91%(5/128),低于急诊PCI组的14.06%(9/64),差异有统计学意义(χ^(2)=6.510,P<0.05)。延迟PCI组的心肌梗死后不稳定型心绞痛及心衰再住院情况均优于急诊PCI组,差异有统计学意义(P均<0.05)。结论与急诊PCI相比,高血栓负荷STMEI患者应用延迟PCI治疗对于改善其心功能及远期预后效果更加明显。Objective To explore and analyze the impact of emergency percutaneous coronary intervention(PCI)and delayed PCI on the prognosis of patients with high thrombotic burden acute ST segment elevation myocardial infarc-tion(STMEI).Methods A total of 192 STEMI patients with high thrombus burden and TIMI level 3 who were hospital-ized in the First Division Hospital of Xinjiang Corps from January 2022 to December 2023 were non-randomly se-lected as the research objects.They were divided into an emergency PCI group(n=64)and a delayed PCI group(n=128)according to the stent placement time.Patients in the emergency PCI group underwent PCI surgery,while those in the delayed PCI group underwent PCI surgery 7-14 days later.The New York Heart Association classification,car-diac function indicators,complications,and long-term prognosis were compared.Results The cardiac function classifi-cation of the delayed PCI group were better than those of the emergency PCI group at 30,90 and 180 days after opera-tion,and the differences were statistically significant(all P<0.05).Compared with the emergency PCI group,the de-layed PCI group at 30 days,90 days,and 180 days after STEMI had a higher left ventricular ejection fraction,lower left ventricular end diastolic diameter,and lower levels of brain natriuretic peptide,the differences were statistically significant(all P<0.05).The total incidence of complications in the delayed PCI group was 3.91%(5/128),lower than 14.06%(9/64)in the emergency PCI group,the difference was statistically significant(χ^(2)=6.510,P<0.05).The read-mission of unstable angina pectoris and heart failure after myocardial infarction in the delayed PCI group were better than those in the emergency PCI group,and the differences were statistically significant(both P<0.05).Conclusion Compared with emergency PCI,delayed PCI treatment has a more significant effect on improving cardiac function and long-term prognosis in STMEI patients with high thrombotic burden.

关 键 词：急诊经皮冠状动脉介入治疗 延迟经皮冠状动脉介入治疗 高血栓负荷 ST段抬高型心肌梗死 心功能 并发症 

分 类 号：R542[医药卫生—心血管疾病]