南通地区不同等级医院急诊经皮冠状动脉介入治疗效果及安全性的比较

Efficacy and safety of primary percutaneous coronary intervention between different types of hospitals in Nantong

目的 :比较南通地区急诊经皮冠状动脉介入治疗(primary percutaneous coronary intervention,PPCI)急性ST段抬高型心肌梗死(ST-elevation myocardial infarction,STEMI)患者在二级医院与三级医院的疗效及安全性。方法:回顾性分析南通地区二级医院和三级医院同期因急性STEMI行PPCI的病历资料,收集患者的基线资料、冠状动脉造影情况,比较即刻造影成功率、院内手术成功率和死亡率的差异。结果:二级医院与三级医院在即刻血管造影成功率(96.3%vs94.4%)、院内手术成功率(94.8%vs 92.0%)和住院死亡率(2.22%vs 3.76%)方面差异无统计学意义(P=0.416、0.316、0.426)。二级医院与三级医院院前延误时间[(6.53±10.00)h vs(7.30±5.50)h]、手术时间[(75.97±27.89)min vs(54.98±19.34)min]及门球时间[(72.02±7.87)min vs(67.87±7.34)min]比较差异均有统计学意义(P=0.025、0.000、0.000)。结论:与三级医院相比,南通地区二级医院急性STEMI患者行PPCI治疗安全有效,同时二级医院在院前时间延误上尚具有优势。

Objective:To compare the efficacy and safety of primary percutaneous coronary intervention(PPCI)for patients with acute ST-elevation myocardial infarction(STEMI)between second-grade class-A hospitals and a third-grade class-A hospital in Nantong.Methods:Patients with acute STEMI undergoing PPCI were enrolled in second-grade class-A hospitals and a third-grade class-A hospital in Nantong retrospectively at the same time.Baseline information and coronary angiography were collected.The differences of the immediate angiographic success rate,the procedural success rate and in-hospital mortality of PPCI in patients of both groups were compared.Results:There were no significantly differences between the two groups in the immediate angiographic success rate(96.3%vs 94.4%),the procedural success rate(94.8%vs 92.0%)and In-hospital mortality(2.22%vs 3.76%)(P=0.416,0.316,0.426).However,compared with the third-grade class-A hospital,the second-grade class-A hospitals were associated with a shorter pre-hospital delay[(6.53±10.00)h vs(7.30±5.50)h],longer operation time[(75.97±27.89)min vs(54.98±19.34)min]and longer Door-to-Balloon time(D-to-B time)[(72.02±7.87)min vs(67.87±7.34)min](P=0.025,0.000,0.000).Conclusions:Compared with the third-grade class-A hospital,our results indicate that PPCI in the second-grade class-A hospitals in Nantong is effective and safe,with the advantage of shorter pre-hospital delay time.