β受体阻滞剂治疗时机不同对冠脉介入患者远期预后的影响

Influence of beta-blockers with different therapy times on patients with acute myocardial infarction conducting percutaneous coronary intervention

目的探讨β受体阻滞剂治疗时机不同对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)患者远期预后的影响。方法采用回顾性研究,根据β受体阻滞剂治疗时机不同,将接受PCI的351例STEMI患者分为早期组(229例,行直接PCI术前即使用)和晚期组(122例,行直接PCI术后至出院前使用)。记录患者的年龄、性别、体质指数、既往史、发病到再灌注时间、Killip分级、冠状动脉病变情况、肌酸激酶(CK)峰值、手术暴露时间、入院时的心率、β受体阻滞剂使用情况、PCI情况等。平均随访时间1.5年,记录患者的再住院率、病死率。结果早期组患者的手术暴露时间明显短于晚期组[(58.6±20.3)min vs.(64.8±22.8)min,t=2.609,P<0.05]。早期组患者再住院率(19.7%vs.29.5%,χ2=4.357,P<0.05)、病死率(1.7%vs.5.7%,χ2=4.176,P<0.05)显著低于晚期组。吸烟、糖尿病、高血压、冠状动脉多支病变严重、发病到再灌注时间>12 h、入院时心率>90次/min是STEMI患者病死的危险因素(OR s>1);Killip分级<Ⅱ级有利于STEM I患者的存活(OR<1)。结论早期服用β受体阻滞剂能够降低行直接PCI术STEM I患者的再住院率、病死率。

Objective To investigate the influence of beta-blockers with different therapy times on patients with ST-segment elevation myocardial infarction（STEMI） conducting percutaneous coronary intervention（PCI）.Methods 351 cases with STEMI were divided into early group（n =229,beta-blockers was used before PCI） and late group（n = 122,beta-blockers was used after PCI and before discharge） by retrospective study.The age,sex,body mass index,past medical history,times to reperfusion after pathogenesis,Killip grading,coronary artery lesion,the peak of creatine kinase（CK）,surgical exposure time,heart rate on admission,beta-blockers use status,and PCI were recorded.Meanwhile,the rehospitalization rate and mortality were followed for average 1.5 years.Results The surgical exposure time of early group was significant lower than that of late group[（58.6 ± 20.3） min vs.（64.8 ± 22.8）min,t = 2.609,P 0.05].The rehospitalization rate（19.7%vs.29.5%,χ～2 = 4.357,P 0.05） and mortality（1.7%vs.5.7%,χ～2 = 4.176,P 0.05） in early group were significant lower than those of late group.The smoking,diabetes,hypertension,coronary artery lesion,times to reperfusion after pathogenesis 12 h,and heart rate on admisObjective To investigate the influence of beta-blockers with different therapy times on patients with ST-segment elevation myocardial infarction（ STEM I） conducting percutaneous coronary intervention（ PCI）. Methods 351 cases with STEM I were divided into early group（ n = 229,beta-blockers was used before PCI） and late group（ n = 122,beta-blockers was used after PCI and before discharge） by retrospective study. The age,sex,body mass index,past medical history,times to reperfusion after pathogenesis,Killip grading,coronary artery lesion,the peak of creatine kinase（ CK）,surgical exposure time,heart rate on admission,beta-blockers use status,and PCI were recorded. M eanw hile,the rehospitalization rate and mortality were follow ed for average 1. 5 years. Results The surgical exposure time of early group was significant low er than that of late group [（ 58. 6 ± 20. 3） min vs.（ 64. 8 ± 22. 8）min,t = 2. 609,P 0. 05]. The rehospitalization rate（ 19. 7% vs. 29. 5%,χ2= 4. 357,P 0. 05） and mortality（ 1. 7% vs. 5. 7%,χ2= 4. 176,P 0. 05） in early group were significant low er than those of late group. The smoking,diabetes,hypertension,coronary artery lesion,times to reperfusion after pathogenesis 12 h,and heart rate on admission 90 times per minute were the risk factors to the survival for patients STEM I（ OR s 1）,w hile Killip grading Ⅱ was the protection factor（ OR 1）. Conclusion Beta-blockers used before PCT can significantly decrease the rehospitalization rate and the mortality of patients with STEM I.