急性ST段抬高型心肌梗死患者发病<12 h与12～48 h行急诊冠状动脉介入治疗疗效及预后分析

Efficacy and prognosis analysis in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention with less than 12 hours and 12-48 hours of onset

目的探讨急性ST段抬高型心肌梗死(STEMI)患者发病<12 h与12~48 h行急诊冠状动脉介入治疗的疗效及预后。方法选取自2017年1月至2018年12月北部战区总医院收治的行急诊冠状动脉介入治疗的1 669例患者为研究对象。根据发病至急诊就诊时间将患者分为A组(发病时间<12 h,n=1 405)与B组(发病时间12~48 h,n=264)。观察并比较两组患者术后全因死亡、心源性死亡、再发心肌梗死、新发脑卒中、出血、再次血运重建、支架内血栓及复合终点事件发生情况。采用生存分析评价不同时间段对STEMI急诊行直接经皮冠状动脉介入治疗的预后影响。结果B组患者多支病变比例显著高于A组,差异有统计学意义(P<0.05);而两组患者的靶病变血管、靶病变术前术后冠状动脉血流心肌梗死溶栓试验(TIMI)血流分级及植入支架总长度比较,差异无统计学意义(P>0.05)。1 669例患者中,失访47例,随访成功率为97.2%(1 622/1 669)。A、B两组患者随访不良事件发生率分别为17.0%(239/1 405)、15.5%(41/264),差异无统计学意义(P>0.05)。多因素COX回归分析显示,B组较A组不良事件发生风险增高,晚期(时间12~48 h)介入治疗为危险因素,但不同时间段(时间<12 h与12~24 h)并非介入术后不良事件发生的独立预测因素(危险比=1.125,95%可信区间0.519~2.438,P>0.05)。结论STEMI患者发病时间>12 h(12~48 h)行介入治疗并非远期不良预后的独立预测因素。

Objective To evaluate the curative effect and prognosis of emergency coronary intervention in patients with acute ST-segment elevation myocardial infarction(STEMI)less than 12 hours and 12-48 hours.Methods A retrospective study was performed on 1 669 cases of patients who underwent emergency coronary intervention from January 2017 to December 2018.Patients were divided into the Group A(onset less than 12 hours,n=1 405)and Group B(onset 12-48 hours,n=264)according to the time from onset to emergency visit.The incidence of postoperative all-cause death,cardiac death,recurrent myocardial infarction,new stroke,hemorrhage,re-revascularization,stent thrombosis and compound end-point events were observed and compared between the two groups.Survival analysis was used to evaluate the effect of different time periods on the prognosis of STEMI patients undergoing direct percutaneous coronary intervention.Results The proportion of multi-vessel lesions in Group B was significantly higher than that in Group A,with statistically significant difference(P<0.05).However,there was no significant difference between the two groups in the classification of target vessels,preoperative and postoperative coronary artery blood flow myocardial infarction thrombolysis test(TIMI)and the total length of stent implantation(P>0.05).Among the 1 669 patients,47 were lost to follow-up,and the follow-up success rate was 97.2%(1 622/1 669).The incidence of adverse events in follow-up was 17.0%(239/1 405)and 15.5%(41/264)in Group A and Group B,respectively,with no statistical significance(P>0.05).Multiariable COX regression analysis showed that the Group B than in Group A increased risk of adverse events,the interventional treatment in 12-48 hours(time)for the risk factors,but different times(less than 12 hours and 12-24 hours)are not after interventional is an independent predictor of adverse events(risk ratio=1.125,95%confidence interval:0.519-2.438,P>0.05).Conclusion Primary percutaneous coronary intervention for STEMI patients over 12 hours(12-48 hours)is not an independent predictor for long-term adverse prognosis.