急性ST段抬高型心肌梗死不同时间段急诊冠状动脉介入治疗疗效观察

Clinical efficacy of primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction at different time after onset

目的探讨急性ST段抬高型心肌梗死(STEMI)患者发病后<12 h及12～48 h行直接经皮冠状动脉介入术(PPCI)的有效性和安全性。方法选取自2017年7月至2018年7月沈阳军区总医院收治的864例STEMI患者为研究对象。将患者分为A组(发病<12 h行PPCI,n=747)和B组(发病12～48 h行PPCI,n=117),比较两组患者PPCI术后心肌梗死溶栓试验(TIMI)血流≤2级及院内临床事件的发生情况。结果 B组发病至就诊时间明显高于A组,组间比较,差异有统计学意义(P <0. 05)。B组KILLIPⅡ级(10. 3%比5. 0%,P <0. 05)及KILLIPⅢ级(5. 1%比1. 3%,P <0. 05)比例均高于A组,组间比较,差异均有统计学意义(P <0. 05)。B组患者桡动脉入路(92. 3%比79. 4%,P <0. 05)比例高于A组,单支病变(9. 4%比16. 8%,P <0. 05)比例低于A组,组间比较,差异均有统计学意义(P <0. 05)。两组在TIMI≤2级血流、TIMI 3级血流比例比较,差异均无统计学意义(P> 0. 05)。两组临床事件的发生情况比较,差异无统计学意义(P> 0. 05)。年龄≥65为术后无复流(TIMI≤2级)发生的独立危险因素。结论对发病12～48 h的STEMI患者行PPCI并未明显增加术后TIMI≤2级的发生率,发病12～48 h行PPCI是安全、有效的。

Objective To investigate the efficacy and safety of primary percutaneous coronary intervention(PPCI)in patients with acute ST elevation myocardial infarction(STEMI)at less than 12 hours and 12 to 48 hours after onset.Methods retrospective study was performed on 864 cases of STEMI patients who were admitted from July 2017 to July 2018.Patients were divided into the Group A(time of onset was less than 12 hours to perform PPCI,n=747)and Group B(time of onset was from 12 to 48 hours to perform PPCI,n=117).TIMI blood flow grade 2 after PPCI and the incidence of clinical events in hospital were compared between the two groups.Results The time between onset and treatment in Group B was significantly higher than that in Group A,and the difference was statistically significant(P<0.05).KILLIPⅡlevel(10.3%versus 5.0%,P<0.05)and KILLIPⅢlevel(5.1%versus 1.3%,P<0.05)ratio in Group B were higher than that in Group A(P<0.05).The proportion of patients with radial artery approach in Group B was higher than that in Group A(92.3%versus 79.4%),and the proportion of single-vessel lesions in Group B was lower than that in Group A(9.4%versus 16.8%,P<0.05).There was no statistically significant difference in the ratio of TIMI less than grade 2 blood flow and TIMI grade 3 blood flow between the two groups(P>0.05).There was no statistically significant difference in the incidence of MACCE events in hospital between the two groups(P>0.05).Aged more than 65 years old was an independent risk factor for postoperative no reflow(TIMI less than grade 2).Conclusion Conclusion The incidence of TIMI grade 2 is not significantly increased by PPCI in STEMI patients with 12 to 48 h ours after onset,and PPCI in patients with 12-48 hours after onset is safe and effective.