超急性期的急性ST段抬高型心肌梗死患者介入治疗临床分析

Clinical analysis of interventional therapy in patients with acute ST segment elevation myocardial infarction in hyperacute stage

目的对照研究超急性期的急性ST段抬高型心肌梗死患者介入治疗的有效性和安全性。方法选取行急诊冠状动脉介入治疗的急性ST段抬高型心肌梗死(STEMI)患者,按照急性心肌梗死发病时间及介入治疗前肌钙蛋白水平,分为超急性期组(49例)和对照组(56例),观察对比两组患者手术的支架植入成功率、术中和围手术期并发症发生率、术后1年的临床主要不良心脏事件的随访结果,并将其危险因素进行logistic多因素回归分析。结果超急性期组比对照组支架植入成功率更高,术中和围手术期并发症发生率、术后1年的临床主要不良心脏事件更低,差异均有统计学意义(P<0.05)。logistic多因素回归分析显示术前肌钙蛋白(OR=4.377,95%CI:1.292-14.826,P=0.018)是STEMI患者急诊支架术后1年临床主要不良心脏事件的独立预测因素。结论超急性期的STEMI患者行急诊冠脉介入治疗具有有效性和安全性,处于超急性期的SEMI患者及早行急诊PCI能进一步降低临床主要不良心脏事件的发生率。

Objective To study the efficacy and safety of interventional therapy in patients with acute ST segment elevation myocardial infarction(STEMI)in hyperacute stage.Methods Acute STEMI patients who underwent emergency coronary intervention were divided into hyperacute group(49 cases)and control group(56 cases)according to the onset time of acute myocardial infarction and the level of troponin before the intervention.The success rate of stent implantation,the incidence of complications during the intraoperative and perioperative period,and the follow-up results of major adverse cardiac eventsone year after the operation in two groups were observed and compared.The risk factors were analyzed by logistic regression analysis.Results The success rate of stent implantation in hyperacute group was higher than that incontrol group,whilethe incidences of complications during the intraoperative and perioperative period,and the major clinical adverse cardiac events one year after the operation were lower in hyperacute group.There were statistically significant differences(P<0.05).Logistic regression analysis showed that preoperative troponin(OR=4.377,95%CI:1.292-14.826,P=0.018)was an independent predictor for major clinical adverse cardiac events in STEMI patients one year after the emergency stenting.Conclusion Emergency coronary intervention is effective and safe for STEMI patients in hyperacute stage,and early emergent PCI can further reduce the incidence of major clinical adverse cardiac events.