急诊介入治疗合并院前心脏骤停急性心肌梗死疗效观察

Outcome of patients with ST-elevation myocardial infarction complicated by pre-hospital cardiac arrest underwent emergency percutaneous coronary intervention

目的 评价急诊经皮冠状动脉介入治疗（PCI）合并院前心脏骤停急性ST段抬高型心肌梗死（STEMI）的临床疗效.方法 入选2004年9月至2008年11月接受急诊PCI的STEMI患者1446例,其中合并院前心脏骤停患者（心脏骤停组）49例,无院前心脏骤停患者（无心脏骤停组）1397例.分析患者住院期间和出院后1年的临床情况,包括总病死率、心脏不良事件、卒中及出血事件等.结果 与无心脏骤停组比较,心脏骤停组急诊PCI成功率差异无统计学意义（88.8%比85.7%,P=0.497）,住院期间心原性休克（3.0%比22.4%,P＜0.001）和心脏骤停（5.9%比44.9%,P＜0.001）的发生率较高,住院期间总病死率较高（2.0%比36.7%,P＜0.001）.发病至院外抢救时间、心脏骤停时心律为心室停顿、入院时Glasgow昏迷评分≤7分和人院时心原性休克是心脏骤停组患者住院期间死亡的独立危险因素.随访1年显示,无心脏骤停组与心脏骤停组总病死率（6.5%比6.9%）、再次心肌梗死（1.4%比3.4%）、再次血运重建（3.4%比6.9%）和卒中发生率（6.4%比6.9%）差异均无统计学意义.结论 与无院前心脏骤停STEMI患者比较,合并院前心脏骤停STEMI患者住院期间病死率较高,但是急诊PCI后1年的疗效相似.

Objective To evalute the outcome of ST-elevation acute myocardial infarction （STEMI）patients complicated pre-hospital cardiac arrest underwent percutaneous coronary intervention （PCI）.Methods From September 2004 to November 2008, 1446 consecutive patients with acute STEMI underwent PCI in our department. 49 out of 1446 patients complicated by pre-hospital cardiac arrest. Clinical outcome including total mortality, adverse cardiac events, stroke and bleeding events during the hospitalization period and within 1 year after discharge was compared between patients with or without pre-hospital cardiac arrest. Results PCI success rate was similar （85.7% vs. 88. 8%, P = 0. 497） while the incidence of inhospital cardiogenic shock 22.4% vs. 3.0%, P 〈 0. 001 and cardiac arrest （44. 9% vs. 5.9%, P 〈0. 001 ） and in-hospital mortality （36. 7% vs. 2. 0%, P 〈0. 001 ） were significantly higher in patients with pre-hospital cardiac arrest than patients without pre-hospital cardiac arrest. Time from symptom onset to emergency treatment, asystole as initial rhythm, Glasgow coma scale （GCS≤7） and cardiogenic shock on admission were independent risk factors of in-hospital death in patients with pre-hospital cardiac arrest.During follow up, incidences of overall mortality, re-infarction, revascularization and stroke were similar between the two groups. Conclusions STEMI patients with pre-hospital cardiac arrest undergoing emergency PCI are facing higher risk of cardiogenic shock and cardiac arrest and higher in-hospital mortality compared to those without pre-hospital cardiac arrest. However, the post-hospital discharge outcome was similar between the two groups.