接受经皮冠状动脉介入治疗的不同缺血时间冠状动脉左主干急性完全闭塞引起心肌梗死患者的临床分析

Clinical analysis of patients with myocardial infarction caused by acute complete left main coronary artery occlusion at different time of ischemia undergoing percutaneous coronary intervention

目的探讨接受经皮冠状动脉介入(PCI)治疗的不同缺血时间冠状动脉左主干(LMCA)急性完全闭塞引起心肌梗死患者的临床特点及近期预后。方法回顾性分析2011年1月至2019年12月于首都医科大学附属北京地坛医院行急诊PCI治疗的12例LMCA急性完全闭塞引起心肌梗死患者的临床资料。以总缺血时间180 min为分界点将患者分为A组(总缺血时间<180 min,6例)和B组(总缺血时间≥180 min,6例)。自行就诊的患者由急诊送入导管室行PCI,入院前已经确诊的经救护车转运的患者绕行急诊送入导管室行PCI。比较2组患者的性别、年龄、体重指数、冠心病(冠状动脉粥样硬化性心脏病)危险因素和既往史等基本资料,心率、血压、术前心功能Killip分级和恶性心律失常发生情况等临床特征,急诊冠状动脉造影和PCI治疗情况,首次医疗接触至球囊扩张时间、门球时间、总缺血时间,以及短期临床预后情况。结果 A组总缺血时间短于B组[(138±35) min比(237±29) min](t=5.382,P <0.001),术后室壁运动积分高于B组[26.5(25.0,40.0)分比23.5(20.5,25.5)分](Z=-2.049,P=0.041)。2组患者的性别、年龄、体重指数、冠心病危险因素和既往史等基本资料,心率、血压、术前心功能Killip分级和恶性心律失常发生情况,急诊冠状动脉造影特征和PCI治疗情况,首次医疗接触至球囊扩张时间、门球时间比较差异均无统计学意义(均P> 0.05)。A组左心房内径、左心室舒张末期内径、左心室射血分数与B组比较差异均无统计学意义(均P> 0.05)。2组术后心功能Killip分级Ⅲ~Ⅳ级各5例、发生需要电转复的持续性室性心动过速/心室颤动各2例,A组发生需要药物复律的持续性室性心动过速1例,置入心律转复除颤器1例,阵发性心房颤动1例,PCI术中和术后24 h内发生心源性死亡各1例;B组术后发生阵发性心房颤动2例,无其他不良心血管事件发生,2组术后短期预后指标比较差异均无统计学意义(均P> 0.05)。结论急诊PCI治疗的LMCA急性完全闭塞引起心肌梗死患者的临床特征及近期预后与总缺血时间无明显相关性。

Objective To investigate the clinical characteristics and short-term outcomes after percutaneous coronary intervention(PCI)in patients with myocardial infarction caused by acute complete left main coronary artery(LMCA)occlusion at different time of ischemia.Methods The clinical data of 12 patients with myocardial infarction caused by acute complete LMCA occlusion who underwent emergency PCI in Beijing Ditan Hospital,Capital Medical University from January 2011 to December 2019 were retrospectively analyzed.According to180 min total ischemic time,patients were divided into group A(total ischemic time<180 min,6 cases)and group B(total ischemic time≥180 min,6 cases).The patients who visited by themselves were sent to the catheterization room from emergency department for PCI,and the patients who had been confirmed by ambulance before admission were sent to the catheterization room for PCI avoiding emergency department.The basic data such as gender,age,body mass index,risk factors of coronary atherosclerotic heart disease(CHD)and previous history,the clinical characteristics such as heart rate,blood pressure,Killip classification of preoperative cardiac function and occurrence of malignant arrhythmia,emergency coronary angiography,PCI treatment,the first medical contact to balloon dilatation time,door-to-balloon time,total ischemia time and short-term clinical prognosis were compared between the two groups.Results The total ischemia time of group A was shorter than that of group B[(138±35)min vs(237±29)min](t=5.382,P<0.001),the postoperative score of ventricular wall motion of group A was higher than that of group B[26.5(25.0,40.0)vs 23.5(20.5,25.5)](Z=-2.049,P=0.041).There were no significant differences in basic data of gender,age,body mass index,risk factors of CHD and previous history,heart rate,blood pressure,Killip classification of preoperative cardiac function,occurrence of malignant arrhythmia,characteristics of emergency coronary angiography,PCI treatment,the first medical contact to balloon dilatation time and door-to-balloon time between the two groups(all P>0.05).There were no significant differences in left atrium diameter,left ventricular end diastolic diameter and left ventricular ejection fraction between group A and group B(all P>0.05).Both groups had each 5 cases of Killip classificationⅢ-Ⅳof preoperative cardiac function,and had each 2 cases of persistent ventricular tachycardia/ventricular fibrillation requiring cardioversion.In group A,1 case of sustained ventricular tachycardia requiring pharmacological cardioversion,1 case implanted with cardioverter,1 case of paroxysmal atrial fibrillation,and each 1 case of cardiac death during and within 24 h after PCI;in group B,there were 2 cases of paroxysmal atrial fibrillation after operation,and no other adverse cardiovascular events occurred.There were no significant differences in short-term prognosis between the two groups(all P>0.05).Conclusion There is no significant correlation between the clinical characteristics,short-term prognosis and total ischemia time in patients with myocardial infarction caused by acute complete LMCA occlusion treated with emergency PCI.