直接经皮冠状动脉介入治疗的610例急性ST段抬高心肌梗死患者临床特征及治疗现状

Clinical characteristic and management of 610 patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

目的研究南京地区接受直接经皮冠状动脉介入治疗(PCI)的急性ST段抬高心肌梗死(STEMI)患者的基线特征及治疗现状。方法回顾性分析610例南京市鼓楼医院因STEMI行急诊PCI患者的临床资料。结果患者平均年龄(64.2±12.3)岁,发病后"症状-进门时间"中位数为180 min,"进门-球囊扩张时间"中位数为100 min。冠状动脉病变以多支病变居多,主要累及左前降支和右冠状动脉。住院期间药物使用率:阿司匹林、氯吡格雷应用率均为100%,低分子肝素/磺达肝癸钠为97.4%、调脂药为92.6%、β-受体阻滞剂为83.8%、血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂(ACEI/ARB)为82.2%。住院期间死亡率为3.6%,多因素分析表明年龄(OR=1.05,P=0.049)、室性心律失常(OR=5.21,P=0.007)、心源性休克(OR=14.54,P=0.000)及术后TIMI血流分级(OR=0.28,P=0.000)与住院期间死亡率有独立的联系。结论南京地区STEMI发病具有年轻化的特点,院前延迟率较高,住院药物治疗与国内外大型研究结果接近,但仍有较大的改善空间。

Objective To study the clinical characteristics and management among acute ST-segment elevation myocardial infarction（STEMI） patients undergoing primary percutaneous coronary intervention （PCI） in Nanjing area. Methods Total 610 patients with acute STEMI admitted to Nanjing Drum Tower Hospital from September 2008 to March 2013 were collected to analyze retrospectively. Results The average age of patients was （64.2＆#177;12.3） years. The median symptom-to-door time was 180 min and the median door-to-balloon time was 100 min.Multivessel lesions were common, mainly involving the left anterior descending artery and right coronary artery. In terms of the patients＆#39; prescription, 100%of patients were prescribed with aspirin and clopidogrel, 97.4%with LMWH/fondaparinux, 92.6% with cholesterol lowering agents, 83.8% with β-blockers, 82.2% with angiotensin converting enzyme inhibitor（ACEI）/angiotensin receptor blocker（ARB） and 66.1%with tirofiban.The in-hospital mortality was 3.6%. Multivariate logistic regression analysis showed that age（OR=1.05, P=0.049）, ventricular arrhythmias（OR=5.21, P=0.007）, cardiogenic shock（OR=14.54, P=0.000） and post-operative TIMI flow（OR=0.28, P=0.000） were independently associated with in-hospital mortality. Conclusion Younger trend and longer pre-hospital delay are commonly seen in STEMI patients. The application of medications is similar to those reported large clinical trials at home and abroad.There is still certain gap of emergency reperfusion therapy with related clinical guidelines of STEMI management. The application status in Nanjing could be further improved.