急性ST段抬高型心肌梗死患者救治时效性改善对临床结局的影响分析

Analysis of effect of the improved door-to-balloon time on clinical outcomes in patients with acute ST-elevation myocardial infarction

目的分析胸痛中心建设前后急性ST段抬高型心肌梗死(STEMI)患者的救治时效性变化,及其对临床结局的影响。方法纳入就诊郑州大学附属洛阳中心医院行经皮冠状动脉介入治疗(PCI)的STEMI患者共861例,分为胸痛中心建设前组(2013年1月至2015年12月,470例)和胸痛中心建设后组(2019年1月至2020年3月,391例)。比较两组的症状发作到首次医疗接触(S2FMC)时间、PCI医院入门到导丝通过(D2W)时间、总缺血时间和临床情况的差异,分析对院内死亡风险的影响。结果与胸痛中心建设前相比,胸痛中心建设后S2FMC时间缩短[1.9 h(0.8,4.7)比3.9 h(2.2,9.1),Z=7.934,P<0.001],D2W时间缩短[52 min(33,82)比80 min(50,818),Z=7.524,P<0.001],总缺血时间缩短[3.9 h(2.2,9.1)比5.6 h(3.5,19.3),Z=6.624,P<0.001],心力衰竭(8.4%比14.3%)、心原性休克(6.4%比9.8%)和恶性心律失常(5.6%比10.4%)的发生率显著下降(均为P<0.05),而院内死亡率无显著变化(6.1%比6.2%,χ2=0.286,P=0.593)。多因素logistic回归分析显示,D2W<60 min与院内死亡风险呈负相关(OR=0.240,95%CI:0.070~0.828,P=0.024),而高血压、2型糖尿病、恶性心律失常、心原性休克、心功能Killip分级Ⅲ~Ⅳ级与院内死亡风险呈正相关(均为P<0.05)。结论胸痛中心建设后STEMI患者的院前、院内救治时效性均显著改善,临床情况更趋稳定,D2W<60 min院内死亡风险下降。

Objective To analyze the time-effectiveness of treatment on clinical outcomes for patients with acute ST-elevation myocardial infarction(STEMI)after chest pain center establishment.Methods A total of 861 STEMI patients who underwent percutaneous coronary intervention(PCI)admitted to Luoyang Central Hospital Affiliated to Zhengzhou University were collected in the study.They were divided into two groups:the pre-construction group(January 2013 to December 2015,470 cases)and the post-construction group(January 2019 to March 2020,391 cases).The differences in symptom-to-first-medical-contact(S2FMC)time,door-to-wire(D2W)time,total ischemia time and clinical outcomes were compared between the two groups,and the impact on the risk of in-hospital death was analyzed.Results Compared to the group before construction of chest pain center,S2FMC time was shortened[1.9 hours(0.8,4.7)vs.3.9 hours(2.2,9.1),Z=7.934,P<0.001],PCI hospital D2W time was shortened[52 minutes(33,82)vs.80 minutes(50,818),Z=7.524,P<0.001],and total ischemia time was shortened[3.9 hours(2.2,9.1)vs.5.6 hours(3.5,19.3),Z=6.624,P<0.001]in the group after construction of chest pain center.The rate of heart failure(8.4%vs.14.3%),cardiogenic shock(6.4%vs.9.8%),and malignant arrhythmia(5.6%vs.10.4%)were significantly lower in the group after construction of chest pain center(all P<0.05).In-hospital mortality did not show difference between the two groups(6.1%vs.6.2%,χ2=0.286,P=0.593).In multivariate regression analysis,D2W<60 minutes was negatively related to the risk of in-hospital mortality(OR=0.240,95%CI:0.070-0.828,P=0.024),while hypertension,diabetes,malignant arrhythmia,cardiogenic shock,and Killip cardiac function classificationⅢ-Ⅳwere positively related to the risk of in-hospital mortality(all P<0.05).Conclusions After the construction of the chest pain center,the timeliness of pre-hospital and in-hospital treatment for STEMI patients are significantly improved.The clinical situation is more stable,and the risk of in-hospital death decreases when D2W<60 min.