急性ST段抬高心肌梗死临床特点及院内再灌注方式对远期死亡的影响

Impact of the clinical features of acute ST-elevation myocardial infarction and in-hospital reperfusion mode on longterm mortality

目的：探讨急性ST段抬高心肌梗死（ST-elevation myocardial infarction，STEMI）的临床特点及院内再灌注方式对远期死亡的影响。方法连续收集我院急救中心2008年1月~2011年12月院前急救的急性STEMI患者80例临床资料，对其19项临床特点和院内再灌注方式（包括溶栓和/或PCI治疗）进行回顾性分析，探讨影响其病死率的危险因素。结果平均随访（42.3±12.3）个月，总病死率为22.5%（18/80），合并心源性休克患者病死率为61.5%（8/13），转诊至有能力行PCI医院者病死率为18.0%（11/61），首次医疗接触至有能力行 PCI 医院的时间为（31.9±14.7）min，转诊至无能力行 PCI医院者病死率为36.8%（7/19）。接受再灌注治疗患者的病死率明显低于未再灌注治疗者（P〈0.001），不同再灌注方式及转诊去向对病死率无显著影响。心源性休克（P〈0.05，RR 8.561，95%CI 1.325~55.324）、未再灌注治疗（P〈0.001，RR 20.860，95%CI 4.431~162.811）是急性STEMI患者死亡的独立预测因素。结论心源性休克、未再灌注治疗是急性STEMI患者死亡的独立预测因素，院前急救STEMI最重要的是尽快行再灌注治疗，降低其病死率。

Objective To investigate the effects of clinical features of acute ST-elevation myocardial infarction and in-hospital reperfusion mode on long-term mortality. Methods Retrospective analysis was performed on eighty consecutive pa-tients with acute ST-elevation myocardial infarction in our hospital from Jan 2008 to Dec 2011. Univariate and multivariate anal-ysis were carried out to assess the predictive value of 19 clinical variables and in-hospital reperfusion mode （including thrombol-ysis and/or PCI）. Explored the factors impacting mortality. Results The mean follow-up was （42.3±12.3） months. The overall mortality was 22.5%（18/80）. In patients with cardiogenic shock, the mortality was 61.5%（8/13）. The mortality of patients ad-mitted at PCI-capable hospital was 18.0%（11/61）, first medical contact （FMC） to device time was （31.9±14.7） minutes,and the mortality of patients who admitted at PCI-incapable hospital was 36.8%（7/19）. The mortality rate was significantly lower in patients undergoing reperfusion therapy than the patients without reperfusion therapy （P〈0.001）. Different reperfusion modes and transportation destination had no significant influence on mortality. By multivariate analysis, cardiogenic shock（P〈0.05, RR 8.561, 95%CI 1.325~55.324） and no reperfusion therapy （P〈0.001, RR 20.860, 95%CI 4.431~162.811） were independent predictors of death in acute STEMI patients. Conclusion In acute STEMI patients, cardiogenic shock and no reperfusion therapy are in-dependent predictors of mortality. For acute STEMI patients, the most important thing is to perform reperfusion therapy as soon as possible to decrease mortality.