急性心肌梗死不同冠脉介入治疗时机的预后分析

Prognostic analysis of acute myocardial infarction with different interventional timing

目的比较不同冠脉介入治疗时机对发病时间超过12 h的急性ST段抬高型心肌梗死患者远期预后的影响。方法连续入选2017年10月至2018年12月河北大学附属医院心内科诊断为急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction,STEMI)且发病时间超过12 h,后行经皮冠脉介入治疗(percutaneous coronary intervention,PCI)的患者173例,根据PCI时机分为早期组(12~24 h,n=81)和晚期组(>24 h,n=92),随访4年。主要终点为心源性死亡、急性心肌梗死,次要终点为明确或可能的支架血栓、缺血驱动的靶血管血运重建、严重心力衰竭(心功能Ⅲ级和Ⅳ级)、恶性心律失常。结果2组4年内急性心肌梗死、明确或可能的支架血栓、缺血驱动的靶血管血运重建、恶性心律失常比较差异无统计学意义;但早期组的严重心力衰竭(心功能Ⅲ级和Ⅳ级)、心源性死亡的发生率高于晚期组,差异均有统计学意义(P<0.05)。结论对于错过最佳PCI时机的急性STEMI患者,24 h之后行PCI心力衰竭、心源性死亡发生率低,有较好的临床预后。

Objective To compare the effect of different timing of coronary intervention on the long-term prognosis of acute ST-segment elevation myocardial infarction patients with onset time over 12 hours.Methods A total of 173 acute ST-segment elevation myocardial infarction patients with onset time over 12 hours from October 2017 to December 2018 in the Department of Cardiology,Affiliated Hospital of Hebei University were admitted,and were divided according to the timing of percutaneous coronary intervention(PCI)into early PCI group(12-24 hours,81 cases)and late PCI group(>24 hours,92 cases).The follow-up period was 4 years.Primary endpoints were cardiogenic death,acute myocardial infarction,and secondary endpoints were definite or probable stent thrombosis,ischemia-driven target vessel revascularization,severe heart failure(NYHA classⅢandⅣcardiac function),and malignant arrhythmias.Results There was no significant difference between the two groups in the incidence of acute myocardial infarction,definite or probable stent thrombosis,target vessel revascularization driven by ischemia and malignant arrhythmia.However,the incidence of severe heart failure(NYHA classⅢandⅣcardiac function),and cardiac death in the early PCI group were higher than that in the late PCI group,and the differences were statistically significant(P<0.05).Conclusion For acute STEMI patients who missed the optimal time of PCI,PCI after 24 hours shows a lower incidence of heart failure and cardiac death and has a better clinical prognosis.