新型冠状病毒肺炎疫情对急性ST段抬高型心肌梗死患者再灌注特征的影响

Impact of COVID-19 pandemic on emergency reperfusion characteristics in patients with ST-segment elevation myocardial infarction

目的探讨新型冠状病毒肺炎疫情对低流行地区的急性ST段抬高型心肌梗死(STEMI)患者急诊机械再灌注特征的影响。方法纳入重庆市新型冠状病毒肺炎疫情期间(2020年1月23日—3月29日)及2019年同期至陆军军医大学第二附属医院胸痛中心接受直接经皮冠状动脉介入治疗(PPCI)的STEMI患者,并排除新型冠状病毒感染患者。比较2020年疫情期间及2019年同期两组患者间的临床特征和再灌注参数。结果共纳入接受PPCI术的STEMI患者64例,分别为疫情期间的13例以及2019年同期的51例。两组患者在临床体征、GRACE评分、就诊时间区间、就诊方式及首次医疗接触至双联抗血小板治疗时间等方面差异无统计学意义(P>0.05)。疫情使接受PPCI治疗的STEMI患者例数明显减少;并使起病至首次医疗接触时间(10 h比3.0 h,P<0.001)、急诊入门至心电图完成时间(6 min比3 min,P<0.001)、急诊入门至完成肌钙蛋白检测时间(15 min比12 min,P=0.048)、急诊入门至导丝通过时间(76 min比62 min,P=0.017)、导管室激活时间(15 min比5 min,P<0.001)和患者进入导管室至导丝通过时间(52 min比41 min,P=0.033)等机械再灌注参数显著延长。结论在低流行地区,新型冠状病毒肺炎疫情仍显著延迟了机械再灌注。

Aim To explore the impact of coronavirus-2019 disease(COVID-19)pandemic on emergency reperfusion characteristics in patients with ST-segment elevation myocardial infarction(STEMI)from non-epicenter.Methods This was a retrospective study involved STEMI patients undergoing primary percutaneous coronary intervention(PPCI),who admitted to chest pain center in our hospital during the pandemic(from January 23 to March 29 in 2020)and the same period in 2019,excluding the patients with COVID-19.Clinical characteristics and reperfusion parameters were compared between the two groups.Results A total of 64 STEMI patients undergoing PPCI were enrolled in our study,including 13 patients during the pandemic and 51 patients during the same period in 2019.No differences occurred in admission signs,GRACE scores,arrival periods,transferred patterns,the period from door to troponin,and the period from first medical contact to dual antiplatelet between the two groups(P>0.05).As compared with 2019,STEMI patients undergoing PPCI had an apparent reduction.Meanwhile,significant delays appeared in reperfusion parameters,including the period from symptom onset to first medical contact(10 h vs.3.0 h,P<0.001),the period from first medical contact to electrocardiogram(6 min vs.3 min,P<0.001),the period from door to troponin(15 min vs.12 min,P=0.048),the period from door to device(76 min vs.62 min,P=0.017),the period from telephone to catheter activated(15 min vs.5 min,P<0.001)and the period from catheter arrival to device(52 min vs.41 min,P=0.033).Conclusion Even in non-epicenter,the COVID-19 outbreak still delayed mechanical reperfusion significantly.