溶栓后区域转运PCI模式对急性ST段抬高型心肌梗死患者的疗效和安全性研究

Curative effect and safety of area transfer PCI after thrombolysis in patients with ST-segment elevation myocardial infarction

目的探讨急性ST段抬高型心肌梗死(STEMI)患者在非经皮冠状动脉介入治疗(PCI)医院溶栓后区域转运PCI模式的疗效和安全性。方法纳入陕西省第四人民医院心血管内科胸痛中心由基层非PCI医院转来且发病时间<24 h的STEMI患者,根据再灌注治疗策略将患者分为溶栓后区域转运PCI组(n=96)和直接PCI组(n=206),收集患者基线资料,比较两组患者介入治疗资料相关指标、主要出血事件以及主要不良心脑血管事件(MACCE)发生率。结果溶栓后区域转运PCI组术前心肌梗死溶栓试验(TIMI)血流0级比例较低,症状发作至球囊扩张时间和基层转运至PCI医院时间有所延长,但症状发作至再灌注治疗时间和患者支架置入比例显著下降,且患者术后LVEF改善显著优于直接PCI组患者[(53.50±7.24)vs.(57.65±8.50),P=0.032];两组住院期间MACCE[9(4.37%)vs.8(8.69%),P=0.175]和主要出血事件发生率[2(0.98%)vs.4(4.35%),P=0.076]无统计学差异。结论首诊于非PCI医院的STEMI患者,溶栓后区域转运PCI模式在一定程度上缩短心肌缺血再灌注时间,有效改善患者心功能,且未增加主要出血事件和院内主要不良心脑血管事件的风险。

Objective To discuss the curative effect and safety of area transfer PCI after thrombolysis in patients with ST-segment elevation myocardial infarction(STEMI).Methods STEMI patients transferred from the basic-level hospitals without PCI with disease attack time<24 h were chosen from Center of Chest Pain of Department of Cardiovascular Medicine in the Fourth People's Hospital of Shaanxi Province.All patients were divided,according to reperfusion therapeutic strategy,into transfer PCI group(after thrombolysis,n=96)and primary PCI group(n=206).The baseline materials were collected from all patients,and indexes related to PCI medical data and incidence rates of major bleeding events and major adverse cardiovascular and cerebrovascular events(MACCE)were compared between 2 groups.Results The percentage of grade 0 of thrombolysis in myocardial infarction(TIMI)was lower in transfer PCI group.The time of door to balloon(D2B)and transfer time from basic-level hospitals to PCI hospital were prolonged,but time of disease attack to reperfusion treatment and percentage of patients with stent implantation decreased significantly in transfer PCI group.The improvement of LVEF after PCI was significantly superior in transfer PCI group than that in primary PCI group[(53.50±7.24)vs.(57.65±8.50),P=0.032].The incidence rate of MACCE[9(4.37%)vs.8(8.69%),P=0.175]and incidence rate of major bleeding events[2(0.98%)vs.4(4.35%),P=0.076]had no statistical difference between 2 groups during hospitalization period.Conclusion The area transfer PCI after thrombolysis can shorten myocardial ischemia reperfusion time to some extent,improve effectively heart function and does not increase the risks of major bleeding events and MACCE in STEMI patients transferred from hospitals without PCI.