广州北部区域胸痛中心直接经皮冠状动脉介入治疗急性ST段抬高型心肌梗死患者的疗效观察

Efficacy of primary percutaneous coronary intervention for patients with acute ST-elevation myocardial infarction in Guangzhou northern chest pain center

目的 探讨广州北部区域某胸痛中心直接经皮冠状动脉介入治疗急性ST段抬高型心肌梗死患者的可行性和疗效.方法 纳入广州市花都区人民医院2016年12月~2019年5月接受直接经皮冠状动脉介入治疗的急性ST段抬高型心肌梗死患者.评估患者的危险因素、治疗时限性和主要心血管不良事件情况.结果 入选患者294例,吸烟者127例(43.2%),合并高血压141例(48.0%),糖尿病57例(19.4%),院前心源性休克40例(13.6%),心脏骤停25例(8.5%).症状-首次医疗接触时间的中位数为93min,门-球时间的中位数为74min,总缺血时间的中位数为226min.梗死相关动脉为左前降支者136例,占46.3%,为右冠状动脉者123例,占41.8%.介入治疗中22例(7.5%)患者单纯行冠脉球囊扩张术272例(92.5%)行支架置入术.术后血管造影无复流或慢血流67例(22.8%),最后达到TIMI 3级血流283例(96.3%).住院期间主要心血管不良事件10例(3.4%),其中死亡6例(死亡率2.0%).结论 在广州北部城乡结合部建立胸痛中心,直接经皮冠状动脉介入治疗急性ST段抬高型心肌梗死患者具有可行性和有效性.

Objective To explore the feasibility and efficacy of primary percutaneous coronary intervention(PCI)for patients with acute ST-elevation myocardial infarction(STEMI)in a chest pain center in northern Guangzhou.Methods Patients with(STEMI)who underwent primary PCI from December 2016 to May 2019 in Huadu District People’s Hospital of Guangzhou City were enrolled.The risk factors,duration of treatment,and major cardiovascular adverse events were evaluated.Results 294 patients were enrolled,including 127 smokers(43.2%),141 with hypertension(48.0%),57 with diabetes(19.4%),40 with pre-hospital cardiogenic shock(13.6%),and 25 with cardiac arrest(8.5%).The median time to symptom-to-first medical exposure was 93 minutes,the median time to door to balloon time was 74 minutes,and the median time to total ischemic time was 226 minutes.136 cases were left anterior descending branch of infarct-related arteries,accounting for 46.3%,and 123 cases were right coronary artery,accounting for 41.8%.In the interventional treatment,22 patients(7.5%)were given coronary balloon dilatation alone,and 272 patients(92.5%)were given stent placement.There were 67 cases(22.8%)with no reflow or slow blood flow after angiography,and 283 cases(96.3%)reached grade 3 TIMI blood flow.There were 10 major cardiovascular adverse events(3.4%)during hospitalization,of which 6 died(death rate of 2.0%).Conclusion Primary PCI for patients with acute STEMI and the establishment of chest pain center at the urban-rural junction in northern Guangzhou are feasible and effective.