非疑似新型冠状病毒肺炎合并急性ST段抬高型心肌梗死患者对急诊介入门囊时间的影响

Impact of COVID-19 outbreak on door to balloon time in ST-segment elevation myocardial infarction patients without coronavirus infection

目的探讨新型冠状病毒肺炎(novel coronavirus pneumonia,COVID-19)疫情对我中心非COVID-19感染合并急性ST段抬高型心肌梗死(ST segment elevation myocardial infarction,STEMI)患者急诊介入门囊(door to balloon,D2B)时间的影响.方法连续入选2019年11月21日至2020年3月20日期间就诊于我中心行急诊经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗的STEMI患者118例,分为两组:2019年11月21日至2020年1月20日行急诊PCI的64例STEMI患者为疫情前组(BC组),2020年1月21日至2020年3月20日行急诊PCI的54例STEMI患者为疫情后组(AC组),比较两组患者的D2B时间.结果疫情期间STEMI患者急诊胸部CT筛查平均耗时(20±9)min.与BC组相比,AC组患者首次医疗接触至首次器械应用(first medial contact to balloon time,FMC2B)中位时间[121(95-153)min比84(59-130)min,P<0.001]及D2B中位时间[94(77-108)min比59(41-73)min,P<0.001]均延长,两组患者的发病至首次医疗接触(FMC)时间、手术操作时间、住院天数以及院内病死率差异均无统计学意义.结论COVID-19疫情导致STEMI患者救治流程发生改变,疫情期间FMC2B及D2B延长,但院内病死率未增加.

Objective To evaluate the impact of novel coronavirus pneumonia(COVID-19)epidemic on door to balloon(D2B)time in patients with ST-segment elevation myocardial infarction(STEMI)without COVID-19 infection.Methods From November 21,2019 to March 20,2020,a total of 118 STEMI patients undergoing primary percutaneous intervention(PCI)in our center after ruling out COVID-19 were consistently observed,who were divided into two groups according to their admitted date:before COVID-19(BC,from November 2,2019 to January 20,2020)group(n=64)and after COVID-19(AC,from January 21,2020 to March 20,2020)group(n=54).The medium D2B time was compared between the two groups.Results The computed tomography(CT)scan consumed a mean time of(20±9)min for eliminating COVID-19 infection in the STEMI patients before primary PCI.Comparing with BC group,patients in AC group had significantly longer first medical contact to balloon(FMC2B)time[121(95-153)min vs.84(59-130)min,P<0.001]and D2B time[94(77-108)min vs.59(41-73)min,P<0.001].There were no differences in the intervals of symptom onset to FMC,procedure time of primary PCI,length of in-hospital stay and mortality.Conclusion Primary PCI pathways may be delayed during the COVID-19 epidemic;patients with STEMI after COVID-19 outbreak experience significantly longer FMC2B and D2B time compared with those with STEMI before COVID-19.In-hospital mortality was not increased.