缩短入门-球囊扩张时间对ST段抬高型心肌梗死患者时间指标及预后的影响

Effect of improved door-to-balloon time on time indices and outcomes of patients with ST-segment elevation myocardial infarction

目的探讨缩短入门-球囊扩张(D2B)时间是否有利于改善首诊于非PCI医院的急性ST段抬高型心肌梗死(STEMI)患者预后。方法入选发病时间小于12 h的STEMI患者200例,记录D2B时间、首次医疗接触-球囊扩张(FMC2B)时间及症状-球囊扩张(S2B)时间。根据D2B时间将患者分为D2B<60组148例和D2B≥60组52例。比较两组首次医疗接触-球囊扩张(FMC2B)和发病-球囊扩张(S2B)时间。随访观察两组主要不良心脑血管事件(MACCE)(包括心原性死亡、非致死性心肌梗死、非致死性卒中、因不稳定型心绞痛或心力衰竭再入院)和全因死亡的情况。采用多因素Cox回归模型分析D2B时间与MACCE发生的关系。结果 D2B<60组FMC2B时间及S2B时间较D2B≥60组短(P=0.013;P=0.027)。与D2B≥60组相比,D2B<60组患者MACCE发生率及全因死亡率减低(P=0.008;P=0.047)。Cox回归分析发现,D2B时间<60 min与MACCE发生相关(HR 0.440,95%CI 0.224~0.862,P=0.017)。结论对于首诊于非PCI医院的STEMI患者,控制D2B时间<60 min可以减少S2B时间,降低MACCE发生率及全因死亡率。

Aim To investigate the effect of improved door-to-balloon(D2 B) time on outcomes in patients diagnosed with ST-segment elevation myocardial infarction(STEMI) in non percutaneous coronary intervention(PCI) centers. Methods A total of 200 STEMI patients within 12 h presenting were enrolled. D2 B time, first medical contact-to-balloon(FMC2 B) time and symptom-to-balloon(S2 B) time were recorded. According to D2 B time, all patients were divided into D2 B<60 group(n=148) and D2 B≥60 group(n=52). FMC2 B time and S2 B time were compared between the two groups. Major adverse cardiac and cerebral events(MACCE, including cardiogenic death, non-fatal myocardial infarction, non-fatal stroke, re-admission of unstable angina or heart failure) and all-cause mortality during follow-up of two groups were observed. Cox regression analysis was used to explore the association of D2 B time and MACCE. Results D2 B<60 group had shorter FMC2 B time and S2 B time than D2 B≥60 group(P=0.013;P=0.027). Compared to D2 B≥60 group, D2 B<60 group had lower MACCE and all-cause mortality(P=0.008;P=0.047). Cox regression analysis showed that a D2 B time less than 60 min was an independent factor associated of MACCE(HR 0.440, 95%CI 0.224~0.862, P=0.017). Conclusion A D2 B time less than 60 min can shorten symptom-to-balloon time and improve MACCE and all-cause mortality in STEMI patients not presenting in PCI center.