急性心肌梗死患者入绿色通道后获益与风险评估

Benefit, risk and management of green channel-percutaneous coronary intervention for patients with acute myocardial infarction

目的通过与常规急性心梗治疗模式比较,对急性心肌梗死患者经绿色通道行急诊经皮冠状动脉介入治疗后1年随访结果进行评估。方法该项前瞻性研究选取了南京市第一医院2011-2013年收治的急性ST段抬高型心肌梗死患者315例,其中绿色通道组68例,非绿色通道组247例。临床结局包括30 d随访内以及1年随访内发生的心源性死亡、非致命性心肌再梗死、靶病变血运重建、确定的支架内血栓及主要不良心脏事件。主要临床终点是1年内主要不良心脏事件的发生率,包括了心源性死亡,非致命性心肌再梗死和靶病变血运重建。结果绿色通道组急性ST段抬高型心肌梗死患者在30 d内心源性死亡(2.9%vs 2.0%)、非致命性心肌再梗死(2.9%vs 2.8%)、确定的支架内血栓(1.5%vs 0.8%)事件的发生率均高于未经绿色通道组救治的患者,而绿色通道组患者靶病变血运重建(1.5%vs 1.6%,P=0.93)及主要不良心脏事件(4.4%vs 5.4%,P=0.78)的发生率均低于非绿色通道组。绿色通道组心梗患者在1年内心源性死亡、非致命性心肌再梗死、靶病变血运重建、确定的支架内血栓及主要不良心脏事件发生率分别为4.4%、2.9%、2.9%、1.5%、5.9%,均小于非绿色通道组(7.3%、4.5%、3.6%、2.4%、11.3%,均P>0.05)。结论与非绿色通道组患者比较,经绿色通道行急诊经皮冠状动脉介入治疗的患者,其1年随访结果事件的发生率均较低。因此,绿色通道的设置对抢救急性心梗患者有益,应积极在中国广泛推行。

Objective To evaluate 1-year clinical outcomes of patients with acute myocardial infarction（AMI） treated by green channel-percutaneous coronary intervention（PCI）, compared with that of patients treated by conventional PCI. Methods This prospective study enrolled 315 patients with AMI in Nanjing First Hospital from2011 to 2013. Out of the 315 patients, 68 were treated by PCI through the green channel（the study group）, while 247 were treated with conventional PCI（the control group）. The clinical outcomes including cardiac death, non-fatal MI,target lesion revascularization（TLR） and stent thrombosis were evaluated at 30 days and 1 year follow-up. The primary endpoint was incidence of major adverse cardiac events（MACE）, a composite endpoint of cardiac death, MI and TLR at 1 year follow-up. Results The incidences of cardiac death（2.9% vs 2.0%）, non-fatal MI（2.9% vs 2.8%）, and stent thrombosis（1.5% vs 0.8%） in the study group were higher than those in the control group at 30 days follow-up.However, the incidences of TLR（1.5% vs 1.6%, P=0.93） and MACE（4.4% vs 5.4%, P=0.78） were both lower than those in the control group. The rates of cardiac death, non-fatal MI, TLR, definite stent thrombosis and MACE in the study group were 4.4%, 2.9%, 2.9%, 1.5%, 5.9%, respectively, which were all lower than those in the control group（7.3%, 4.5%, 3.6%, 2.4%, 11.3%）, with no statistically significant differences（all P〉0.05）. Conclusion Compared with the patients treated with conventional PCI, patients treated by primary PCI through the green channel show more benefits, with lower incidences of clinical outcomes at 1 year follow-up. The administration of green channel should be recommended in clinical practice in China, which could be beneficial to patients with AMI.