经皮冠状动脉介入时机对急性心肌梗死伴充血性心力衰竭患者的疗效和安全性

The efficacy and safety of percutaneous coronary intervention timing in patients with acute myocardial infarction and congestive heart failure

目的分析早期与延迟经皮冠状动脉介入(PCI)治疗对非ST段抬高型心肌梗死(NSTEMI)伴充血性心力衰竭患者疗效和安全性的影响。方法回顾性将2016年1月至2019年1月石棉县人民医院收治的NSTEMI伴充血性心力衰竭患者300例纳入研究,根据患者介入时间不同将其分为早期PCI组(发病24 h内)148例及非早期PCI组(发病24~72 h内)152例,比较两组患者临床基线资料、PCI术相关因素、心脏结构及功能等相关指标,并对患者术后进行为期12个月的随访,记录并比较患者PCI主要并发症的发生情况及主要心血管不良事件(MACE)发生情况。结果早期PCI组患者TIMI血流3级患者比例明显高于非早期PCI组(χ^(2)=4.014,P<0.05),而PCI并发症总发生率及MACE累积发生率明显低于非早期PCI组(χ^(2)=3.175、4.533,均P<0.05)。结论对合并充血性心力衰竭的NSTEMI患者,早期PCI术能有效恢复冠状动脉血流,并发症更低,术后1年累积MACE发生率更低。

Objective To analyze the effects of early and delayed percutaneous coronary intervention(PCI)treatment on the efficacy and safety of patients with non-ST-segment elevation myocardial infarction(NSTEMI)and congestive heart failure.Methods 300 patients with NSTEMI and congestive heart failure admitted to People's Hospital of Shimian Country from January 2016 to January 2019 were included retrospectively.According to the time of intervention,the patients were divided into early PCI group(within 24h of onset)with 148 cases and non-early PCI group(within 24 to 72 hours of onset)with 152 cases.The clinical baseline data,PCI related factors,cardiac structure and function and other related indicators of the two groups were compared,and the patients were treated followed up for 12 months after surgery.The occurrence of major complications of PCI and major adverse cardiovascular events(MACE)were compared between the two groups.Results The proportion of TIMI blood flow grade 3 patients in the early PCI group was significantly higher than that in the non-early PCI group(χ^(2)=4.014,P<0.05),and the total incidence of PCI complications and the cumulative incidence of MACE were significantly lower than those in the non-early PCI group(χ^(2)=3.175,4.533;both P<0.05).Conclusion For NSTEMI patients with congestive heart failure,early PCI can effectively restore coronary blood flow,are association with lower complications and a lower cumulative incidence of MACE 1 year after surgery.