经桡动脉直接单指引导管方法对ST段抬高型心肌梗死患者介入治疗的可行性分析

Feasibility of a single catheter intervention using the transradial approach for ST-segment elevation myocardial infarction

目的评估依据心电图结果、经桡动脉途径对急性ST段抬高型心肌梗死(STEMI)患者直接行经皮冠状动脉介入治疗(PCI)的安全性及有效性。方法回顾性分析汕头市第二人民医院2015年1月至2019年6月诊断为STEMI且有急诊冠状动脉造影及 PCI指征患者298例的临床资料, 将患者分为传统经股动脉组(TTFI组)56例、传统经桡动脉组(TTRI组)167例与单指引经桡动脉组(STRI组)75例。比较三组门-球囊(D2B)时间、穿刺至球囊(N2B)时间、住院时间及1年主要不良心脏事件(MACE)发生率。结果 STRI组、TTFI组、TTRI组D2B时间分别为(67.6±2.1)min、(73.3±15.3)min、(77.4±16.7)min, 三组差异有统计学意义(F=-2.24, P=0.013), STRI组D2B时间均短于TTFI组、TTRI组(t=-1.84、-1.84, 均P=0.033)。STRI组、TTFI组、TTRI组N2B时间分别为(7.6±2.1)min、(15.3±6.5)min、(14.1±5.7)min, 三组差异有统计学意义(F=-4.34, P < 0.001), STRI组N2B时间均短于TTFI组、TTRI组(t=-2.06, P=0.020;t=-3.12, P < 0.001)。STRI组D2B时间少于90 min的患者比例为74.7%(56/75), 均显著高于TTRI组[46.1%(77/167)]、TTFI组[51.8%(29/56)](χ^(2)=4.07, P < 0.001)。TTFI组、TTRI组、STRI组患者1年MACE发生率分别为16.1%(9/56)、13.2%(22/167)、9.3%(7/75), STRI组MACE发生率显著低于TTFI和TTRI组(χ^(2)=5.67, P < 0.05)。结论 STRI对于 STEMI患者安全有效, 有望能改善远期预后。

Objective To evaluate the safety and effectiveness of primary percutaneous coronary intervention using the transradial approach in patients with acute ST-segment elevation myocardial infarction(STEMI)based on electrocardiography results.Methods The clinical data of 298 patients with STEMI who had indications of emergency coronary angiography and percutaneous coronary intervention who received treatment in The Second People's Hospital of Shantou between January 2015 and June 2019 were retrospectively included in this study.These patients were assigned into traditional transfemoral intervention(TTFI,n=56),traditional transradial intervention(TTRI,n=167),and single transradial intervention(STRI,n=75)groups.Door-to-balloon(D2B)time,needle-to-balloon(N2B)time,hospital days,and the incidence of major adverse cardiac events within 1 year after treatment were compared among the three groups.Results The D2B time in the STRI,TTFI and TTRI groups was(67.6±2.1)minutes,(73.3±15.3)minutes,and(77.4±16.7)minutes,respectively.There was a significant difference in D2B time among the three groups(F=-2.24,P=0.013).The D2B time was significantly shorter in the STRI group than in the TTFI and TTRI groups(t=-1.84,-1.84,both P=0.033).The N2B time in the STRI,TTFI and TTRI groups was(7.6±2.1)minutes,(15.3±6.5)minutes,and(14.1±5.7)minutes,respectively.There was a significant difference in N2B time among the three groups(F=-4.34,all P<0.001).The N2B time was significantly shorter in the STRI group than in the TTFI and TTRI groups(t=-2.06,P=0.020;t=-3.12,P<0.001).The proportion of patients with D2B time less than 90 minutes in the STRI group was 74.7%(56/75),which was significantly higher than that in the TTRI[46.1%(77/167)]and TTFI[51.8%(29/56)]groups(χ^(2)=4.07,P<0.001).The incidence of major adverse cardiac events within 1 year after treatment in the TTFI,TTRI,and STRI groups was 16.1%(9/56),13.2%(22/167),and 9.3%(7/75),respectively.The incidence of major adverse cardiac events within 1 year after treatment was significantly lower in the STRI group than in the TTFI and TTRI groups(χ^(2)=5.67,P<0.05).Conclusion STRI is safe and effective for STEMI and is expected to improve long-term prognosis.