经PCI治疗ST段抬高型心梗患者DTB与死亡率的关联

Association Between DTB and Mortality in Patients with ST-segment Elevation Myocardial Infarction Treated by PCI

目的探讨入院至球囊扩张时间(DBT)间隔进一步缩短对初次接受经皮冠状动脉介入治疗(PCI)ST段抬高型心肌梗死(STEMI)患者预后的影响。方法研究对象为111例成功行PCI的STEMI患者,而且DBT≤90min。根据DBT将患者分为2组:<60min(n=76)和60~90min(n=35)。比较2组患者住院并发症发生率、30d和1年死亡率。结果与DBT60~90min组的患者相比,DBT<60min患者主要在白天和工作日发生,术后左心室射血分数更好,30d死亡率更低(2.6%vs.5.7%,P=0.034)。DBT<60min患者1年死亡率3.9%明显低于DBT60~90min患者(P=0.003,11.3%)。逻辑回归分析显示,DBT<60min与1年死亡率风险降低相关(OR=0.48,95%CI:0.25~0.93,P=0.036)。结论经PCI治疗STEMI患者DBT<60min与较低的1年死亡率独立相关。

Objective To investigate the possible impact of further reduction in door-to-balloon time (DBT) intervals beyond the 90 min cutoff on outcomes among ST-segment elevation myocardial infarction(STEMI) patients undergoing primary percutaneous coro. nary intervention(PCI). Methods We retrospectively studied 111 STEMI patients who underwent successful primary PCI and had a DBT of ≤ 90 min. Patients were stratified according to DBT into 2 groups:< 60 min(n=76) and 60 ~ 90 min(n=35). Patients records were assessed for the occurrence of in-hospital complications, 30-day and 1-year mortality. Results Patients having DBT < 60 min were more likely to in daytime and weekdays, and had better post- procedural left ventricular ejection fraction and lower 30-day mor. tality (2.6%vs.5.7%,P=0.034). Mortality over 1-year was significantly lower among patients having DBT < 60 compared to DBT of 60 ~ 90 min (3.9%vs. 11.3%,P=0.003). In a logistic regression model DBT < 60 min was associated with 51% risk reduction for 1- year mortality (OR: 0.48, 95% CI: 0.25 ~ 0.93, P=0.036). Conclusions Among STEMI patients undergoing primary PCI within 90 min of admission DBT < 60 min was independently associated with better 1-year mortality.