不同年龄段ST段抬高型心肌梗死患者行急诊PCI治疗时救治延误的差异及分析

Age-related differences on treatment delay of ST segment elevation myocardial infarction patients treated by primary percutaneous coronary intervention

目的:探究不同年龄段ST段抬高型心肌梗死(STEMI)患者行急诊经皮冠状动脉介入治疗(PCI)时救治延误的差异。方法:回顾性分析2017-01-2019-06就诊于成都地区9家胸痛中心行急诊PCI的STEMI患者1 090例。对年龄采取四分位法分组,将患者分成4组:<55岁组(A组:265例);55~65岁组(B组:275例);66~75岁组(C组:275例);≥76岁组(D组:275例)。分析各组患者救治延误的差异,并使用logistic回归模型分析年龄及其他因素对发病至首次医疗接触时间(S2FMC)的影响。结果:随年龄增加,各组患者S2FMC时间(100 min:115 min:131 min:168 min)逐渐延长(P<0.05);各组首次医疗接触至球囊开通梗死血管的时间(118 min:117 min:122 min:125 min)差异无统计学意义(P>0.05);多因素logistic回归分析显示,年龄(OR=1.015,95%CI:1.004~1.025,P=0.006)、是否EMS来院(OR=1.656,95%CI:1.204~2.278,P=0.002)与S2FMC时间延长相关。结论:随着年龄增长,行急诊PCI治疗的急性STEMI患者S2FMC逐渐延长,需加强对老年患者的健康教育,以提高对STEMI的认识,尽可能缩短高龄STEMI患者的救治延误。

Objective:To investigate the aged-related differences on the treatment delay of patients with ST-elevation myocardial infarction(STEMI) treated by primary percutaneous coronary intervention(PCI).Method:A total of 1 090 STEMI patients who were treated by primary PCI in 9 chest pain centers in Chengdu from January 2017 to June 2019.Patients were divided into 4 groups according to age:<55 years old group(group A:265 patients);55~65 years old group(group B:275 patients);66~75 years old group(group C:275 patients);≥76 years old group(group D:275 patients).The differences in treatment delay of each group were analyzed,and the effects of age and other factors on time from symptom onset to first medical contact(S2 FMC) were analyzed by logistic regression model.Result:With the increase of age,S2 FMC time(100 min vs 115 min vs 131 min vs 168 min) in each group was gradually prolonged(P<0.05).FMC2 B time(118 min vs 117 min vs 122 min vs 125 min) of each group showed no statistical significant difference(P>0.05).Multivariate logistic regression analysis showed that age(OR=1.015,95%CI:1.004-1.025,P=0.006) and whether EMS was admitted to hospital(OR=1.656,95%CI:1.204-2.278,P=0.002) were correlated with the extension of S2 FMC time.Conclusion:The time from symptom onset to first medical contact(S2 FMC) of STEMI patients treated by primary PCI gradually increases with age.So it is necessary to strengthen health education for elderly patients in order to improve the understanding of STEMI and shorten the treatment delay of elderly STEMI patients as far as possible.