COVID-19防控对急性ST段抬高型心肌梗死住院患者救治的影响

Prevention and control measures of COVID-19 on the treatment of inpatients with acute ST-segment elevation myocardial infarction

目的研究分析新型冠状病毒肺炎(COVID-19)不同时期防控措施对急性ST段抬高型心肌梗死(STEMI)住院患者的救治和院内病死率影响。方法回顾性分析苏州大学附属第三医院心内科2019年1月25日至2019年2月25日(COVID-19非流行期间组)、2020年1月25日至2020年2月25日(COVID-19一级响应组)、2021年1月25日至2021年2月25日(COVID-19常态化防控组)三个时期的STEMI住院患者,比较分析不同疫情防控措施下研究对象的就诊时间、治疗策略、首次医疗接触时间(FMC)、球囊扩张时间(D-to-B)以及院内全因病死率等指标。结果共纳入107例STEMI患者,其中非流行期间组37例,一级响应组28例,常态化防控组42例;三组急诊溶栓和FMC以及D-to-B时间差异有统计学意义(P<0.05);COVID-19一级响应组的FMC时间[14.0(7.0,21.3)min]显著长于非流行期间组[8.0(5.0,10.0)min]和常态化防控组[5.0(4.0,6.5)min](P<0.05),D-to-B时间较非流行期间组显著延长[87.5(68.8,116.3)h vs 67.5(55.0,91.3)h,P<0.05];一级响应组院内病死率显著高于常态化防控组(28.6%vs 4.8%,P<0.05);一级响应组非PCI患者病死率高于PCI患者(17.4%vs 80.0%,P<0.05)。结论COVID-19一级响应期间STEMI患者急诊再灌注的救治时间延长,在遵循COVID-19防控原则基础上,通过优化STEMI的救治流程可以降低院内全因死亡率。

Objective To study and analyze the impacts of different prevention and control measures of COVID-19 on the treatment of hospitalized patients with acute ST segment elevation myocardial infarction(STEMI)and on in-hospital mortality of STEMI.Methods The patients with STEMI were respectively enrolled from those admitted to hospital between January 25,2019 and February 25,2019(COVID-19 non-epidemic group),between January 25,2020 and February 25,2020(COVID-19 primary response group)and between January 25,2021 and February 25,2021(COVID-19 normalized prevention and control group).The treatment time and strategy,the first medical contact(FMC)time,balloon dilation(door-to balloon,D-to-B)time and all-cause mortality in hospital were retrospectively analyzed and compared under different prevention and control measures for COVID-19 epidemic.Results A total of 107 patients with STEMI were enrolled,including 37 cases in non-epidemic group,28 cases in primary response group and 42 cases in normalized prevention and control group.There were significant differences in the time for thrombolysis,FMC and D-to-B time among three groups(P<0.05).FMC time in primary response group[14.0(7.0,21.3)min]was significantly longer than those in non-epidemic period group[8.0(5.0,10.0)min]and normalized prevention and control group[5.0(4.0,6.5)min](P<0.05),and D-to-B time was significantly longer than that in non-epidemic period group[87.5(68.8,116.3)h vs 67.5(55.0,91.3)h,P<0.05].The in-hospital mortality in primary response group was significantly higher than that in normalized prevention and control group(28.6%vs 4.8%,P<0.05).The mortality of patients without undergoing PCI was statistically higher than that of PCI patients in primary response group(17.4%vs 80.0%,P<0.05).Conclusions During the primary response to COVID-19 epidemic,the re-perfusion treatment time for STEMI patients is prolonged.The all-cause mortality in hospital can be reduced by optimizing emergency strategy of STEMI based on the principles of COVID-19 pandemic prevention and control.