不同时间窗延迟经皮冠状动脉介入治疗对急性ST段抬高型心肌梗死患者预后的影响

Prognostic effects of delayed percutaneous coronary intervention at different time windows on patients with acute ST-segment elevation myocardial infarction

目的 探讨不同时间窗延迟经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）对急性ST段抬高型心肌梗死（ST-elevation myocardial infarction,STEMI）患者预后的影响.方法 将2010年1月至2013年1月因STEMI入住广东药学院第一附属医院的109例患者分为两组：A组55例（PCI治疗时间窗为12～24 h）,B组54例（PCI治疗时间窗为5～14 d）.A组行延迟PCI治疗后予积极药物治疗,B组经积极药物治疗患者病情稳定后行延迟PCI治疗.于入院3d内、1个月、1年分别行超声心动图检查,计算左心室收缩末容积指数（LVESVI）、左心室舒张末容积指数（LVEDVI）和左心室射血分数（LVEF）,并判断左心功能的状况以及观察患者发病后1年内主要心血管事件（MACE）的发生情况.结果 两组患者术前基本临床情况以及术中情况比较,差异无统计学意义（P＞0.05）.两组在入院3d内左心功能比较,差异无统计学意义（P＞0.05）;术后1个月、1年两组患者左心功能均有改善,A组左心功能改善程度明显比B组好,差异有统计学意义（P＜0.05）.A组在复合心血管事件、心力衰竭以及心源性病死率等方面较B组明显下降,差异有统计学意义（P＜0.05）.结论 错过最佳再灌注时机的急性STEMI患者在发病24 h内行延迟PCI治疗仍可使患者更多获益.

Objectives To compare the prognostic effects of different time windows on delayed percutaneous coronary intervention （PCI） on patients with acute ST-elevation myocardial infarction （STEMI）.Methods Totally 109 patients with ST-segment elevation myocardial infarction （STEMI） in The First Affiliated Hospital of Guangdong College of Pharmacy were enrolled continuously from January 2010 to January 2013.According to the timing of delayed PCI,the patients were divided into 2 groups：group A （timing at 12-24 h,drug therapy after PCI,n=55）,group B （timing at 5-14 d,PCI after drug therapy,n=54）.Left ventricular end-systolic volume index （LVESVI）,left ventricular end-diastolic volume index （LVEDVI） and left ventricular ejection fraction （LVEF） were determined by echocardiogram within 72 hours,1 month and 1 year after admission.Left cardiac function was evaluated.Occurrence of major adverse cardiovascular events （MACE） in the two groups was compared.Results The basic data and information before and during operation of the two group had no significant difference（P〉0.05）.There was no significant difference in left cardiac function between the two groups at the first 3 d after admission（P〉0.05）.However,1 month and 1 year after PCI,the left cardiac functions in group A were significantly better than those in group B （P〈0.05）.The incidence of MACE,heart failure and mortality in group A was significantly lower than that in group B（P〈0.05）.Conclusions Delayed PCI at time windows within 24 h can still improve the prognosis of patients with STEMI.