急性ST段抬高心肌梗死患者近期预后研究

Study on short term prognosis in patients with acute ST-segment elevation myocardial infarction

目的研究近6年来雅安地区急性ST段抬高心肌梗死(STEMI)患者的近期预后变化趋势。方法收集雅安市人民医院2010年1月至2016年1月接受直接经皮冠状动脉介入治疗(PCI)的全部STEMI患者资料,根据住院时间将患者分为第一组(2010年1月至2013年1月,132例)、第二组(2013年1月至2016年1月,264例)。分析两组危险因素、药物、PCI情况及90 d预后的变化趋势。结果本研究共入选396例STEMI患者,平均年龄(62.8±12.5)岁,男316例(79.8%)。两组糖尿病患者比例分别为22.7%和32.6%,有显著升高趋势(P=0.047);入院时高敏肌钙蛋白T分别为(1 593±2 489)pg/m L和(517±773)pg/m L,有显著下降趋势(P=0.005);症状-入门时间分别为346.5(30,825)min和207.5(17,648)min,有明显降低趋势(P=0.022);入门-球囊扩张时间分别为92(50,190)min和55(20,124)min,有显著降低趋势(P=0.000);血栓抽吸比例分别为6.1%和15.2%,PCI成功率分别为87.9%和97.3%,均有显著升高趋势(P=0.009、0.000);术后TIMI血流Ⅲ级比例分别为89.4%和96.2%,有明显升高趋势(P=0.012)。两组患者首诊医院阿司匹林300 mg嚼服率分别为74.2%和97.7%,硫酸氢氯吡格雷300 mg口服率分别为56.8%和95.3%,肝素使用率分别50.0%和88.6%,血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂使用率分别为9.8%和31.1%,均有显著升高趋势(P<0.01);住院时间分别为9(4,15)d和5(4,14)d,有显著缩短趋势(P<0.01)。在90 d预后方面,与第一组比较,校正相关基线因素后,第二组全因死亡率明显下降[相对风险(RR)0.568,95%置信区间(CI)0.369~0.825,P=0.001]。结论近6年来雅安地区STEMI患者近期预后显著改善,主要获益于直接PCI。

Objective To investigate the short-term prognosis change trend in the patients with acute ST-segment elevation myocardial infarction（STEMI）in Ya′an area over the past 6 years. Methods The whole data in the patients with STEMI receiving direct percutaneous coronary intervention（PCI）in the Ya ′an Municipal People ′s Hospital from January 2010 to January 2016 were collected. The patients were divided into the first group（132 cases,from January 2010 to January 2013）and second group（264 cases,from January 2013 to January 2016）. Then the risk factors,drugs,PCI and 90 d prognosis change trend were assessed in the two groups. Results A total of 396 cases of STEMI were included with the mean age of（62.8 ±12.5）years old,316 males（79.8%）. The proportions of diabetic patients in the two groups were 22.7% and 32.6% respectively,showing a significantly increasing trend（P=0.047）;the high sensitive troponin T at admission was（1 593±2 489）pg/m L and（517±773）pg/m L,showing a significantly decreasing trend（P=0.005）;the symptom-to-balloon time was 346.5（30,825）min and207.5（17,648）min,showing a significantly increasing trend（P=0.022）,the door-to-balloon dilation time was 92（50,190）min and 55（20,124）min,showing a significantly decreasing trend（P=0.000）;the thrombus aspiration ratios were 6.1% and15.2% respectively,the PCI success rates were 87.9% and 97.3% respectively,showing a significantly increasing trend（P=0.009,P=0.000）;the ratios of postoperative TIMI blood flow gradeⅢ were 89.4% and 96.2%,showing a significantly increasing trend（P=0.012）. The chewing rate of aspirin 300 mg at the initial hospital in the two groups were 74.2% and 97.7% respectively,the orally taking rates of clopidogrel hydrogen sulfate 300 mg were 56.8% and 95.3% respectively,and the use rates of heparin were 50.0% and 88.6% respectively,and the use rates of platelet glycoproteinⅡb/Ⅲa receptor antagonist were 9.8%and 31.1% respectively,all showing a significantly increasing trend（P〈0.01）. The hospitalization time were 9（4,15）d and 5（4,14）d respectively,showing a significantly decreasing trend（P〈0.01）. In the aspect of 90 d prognosis,After adjusting the related baseline factors,the all-cause mortality rate in the second group was significantly declined compared with the first group[relative risk（RR）0.568,95% confidence interval（CI）0.369-0.825,P=0.001）. Conclusion The short term prognosis in the patients with STEMI in Ya′an during the recent 6 years has been significantly improved,which mainly obtain the benefit from direct PCI..