紧急介入治疗对高危急性非ST段抬高性心肌梗死患者12个月临床结果的影响

Influence of emergency PCI on 12-month clinical outcomes in patients with high-risk acute on-ST-segment elevation myocardial infarction

目的比较紧急经皮冠状动脉介入治疗(PCI)与早期PCI策略对高危急性非ST段抬高型心肌梗死(NSTEMI)患者12个月临床终点的影响。方法连续收集自2018年1月1日至2018年12月31日于武汉亚洲心脏病医院行PCI的高危NSTEMI患者127例,依据介入治疗时间窗分为紧急PCI组(确诊后2 h内行PCI者81例)和早期PCI组(确诊后2~24 h内行PCI者46例),主要终点是术后12个月主要不良心血管事件(MACE,定义为心源性死亡、再发非致命性心肌梗死)。回顾性对比分析两组基线临床资料、冠状动脉(冠脉)影像特征、PCI相关数据以及主要终点。结果紧急PCI组和早期PCI组从确诊到行PCI的中位数时间分别为73 min和285 min(P<0.001)。在3个月及12个月随访时,两组主要终点MACE事件发生率均较低,且组间差异无统计学意义(P>0.05),两组心源性死亡与再发非致命性心肌梗死均无统计学差异(P>0.05)。但紧急PCI组男性比例及既往有高血压病史的比例高于早期PCI组,差异有统计学意义(P<0.05)。紧急PCI组入院时白细胞计数、粒细胞计数均高于早期PCI组,淋巴细胞计数低于早期PCI组,差异有统计学意义(P<0.05)。结论紧急介入治疗不能降低高危NSTEMI患者PCI后12个月的MACE发生率。

Objective To compare the influence of emergency percutaneous coronary intervention(PCI)and early PCI strategy on 12-month clinical outcomes in patients with high-risk acute on-ST-segment elevation myocardial infarction(NSTEMI).Methods The patients with high-risk acute NSTEMI(n=127)undergone PCI were chosen from Wuhan Asia Heart Hospital from Jan.1,2018 to Dec.1,2018.All patients were divided,according to PCI time window,into emergency PCI group(received PCI within 2 h after diagnosis,n=81)and early PCI group(received PCI within 2 h to 24 h,n=46).The major outcomes were major adverse cardiovascular events(MACE)after PCI for 12 months,including cardiac death and relapse nonfatal myocardial infarction.The baseline clinical materials,characteristics of coronary angiography(CAG),data related to PCI and primary endpoint events were retrospectively compared and analyzed in 2 groups.Results The median time from diagnosis to PCI performance was 73 min in emergency PCI group and 285 min in early PCI group(P<0.001).During 3-month and 12-month follow-up period,the incidence rate of MACE was lower in 2 groups and difference had no statistical significance between 2 groups(P>0.05),and incidence of cardiac death and relapse nonfatal myocardial infarction had no statistical difference between 2 groups(P>0.05).The percentages of male cases and cases of hypertension history were higher in emergency PCI group than those in early PCI group(P<0.05).The levels of white blood cell count and neutrophil count were higher,and level of lymphocyte count was lower in emergency PCI group than those in early PCI group(P<0.05).Conclusion Emergency intervention therapy can no reduce MACE incidence rate in patients with high-risk acute NSTEMI after PCI for 12 months.