溶栓后早期转运经皮冠状动脉介入治疗对急性ST段抬高型心肌梗死患者的心功能及预后的影响

Impact of Early Post~Thrombolysis Transfer for PCI on Cardiac Function and Prognosis in Patients with Acute ST Segment Elevation Myocardial Infarction

目的分析探讨溶栓后早期转运经皮冠状动脉介入治疗(Percutaneous Coronary Intervention,PCI)对急性ST段抬高型心肌梗死(ST segment Elevation Myocardial,STEMI)患者心功能及预后的影响。方法选择新疆生产建设兵团第一师医院就诊的194例STEMI患者为研究对象,根据早期再灌注治疗方式分为2组,未经转诊直接就诊我院并进行PCI治疗患者归为对照组(92例),在基层医院溶栓后尽快转运至我院完成PCI治疗患者归为观察组(96例)。对比两种治疗方式对STEMI患者医疗救治节点时间数据、心室重构、心功能、主要心血管不良事件(Major Adverse Cardiovascular Events,MACE)的发生风险及生存率的影响。结果两组患者症状发作至首次医疗接触时间比较无差异(P>0.05),首次医疗接触至启动再灌注时间、入行PCI的医院大门至球囊扩张时间观察组低于对照组(P<0.05)。两组患者左室舒张末内径大小(Left Ventricular End-Diastolic Diameter,LVEDD)、左室射血分数(Left Ventricular Ejection Fraction,LVEF)在住院期间、心肌梗死后3个月、心肌梗死后6个月、心肌梗死后12个月无明显差异(P>0.05)。两组患者随访期间全因死亡、心血管死亡、再次心肌梗死、新发需要治疗的心力衰竭及其构成的MACE事件总和无明显差异(P>0.05)。MACE事件对两组患者的Kaplan-Meier生存分析分布无差异(P=0.545)。结论在基层医院溶栓后早期转运PCI可以缩短医疗接触至启动再灌注时间、入行PCI医院大门至球囊扩张时间,与直接急诊PCI治疗相比不会增加急性心功能不全、心肌梗死后患者心室重构、心功能下降及MACE事件的发生风险,不会降低生存率。

Objective This study aims to analyze and discuss the impact of early transfer for percutaneous coronary intervention(PCI)after thrombolysis on cardiac function and prognosis in patients with acute ST-segment elevation myocardial infarction(STEMI).Methods 194 STEMI patients treated at the First Division Hospital of Xinjiang Production and Construction Corps were selected as the study subjects.Based on early reperfusion treatment methods,patients were divided into two groups:the control group(92 patients),who were directly admitted to our hospital for PCI without referral,and the observation group(96 patients),who were transferred to our hospital for PCI as soon as possible after thrombolysis at a primary care hospital.The study compared the impact of these treatment methods on the timing of medical treatment milestones,ventricular remodeling,cardiac function,the risk of major adverse cardiovascular events(MACE),and survival rates in STEMI patients.Results There was no significant difference between the two groups in the time from symptom onset to the first medical contact(P>0.05).However,the time from the first medical contact to the initiation of reperfusion and the time from entering the PCI-performing hospital to balloon dilation were significantly shorter in the observation group compared to the control group(P<0.05).There were no significant differences in left ventricular end~diastolic diameter(LVEDD)or left ventricular ejection fraction(LVEF)between the two groups during hospitalization,at three months,six months,and twelve months post-myocardial infarction(P>0.05).Additionally,there was no significant difference in the incidence of all-cause mortality,cardiovascular mortality,recurrent myocardial infarction,newly diagnosed heart failure requiring treatment,or the total number of MACE events during the follow-up period between the two groups(P>0.05).Kaplan-Meier survival analysis showed no significant difference in the distribution of MACE events between the two groups(P=0.545).Conclusion Early transfer for PCI after thrombolysis at primary care hospitals can shorten the time from medical contact to reperfusion initiation and the door-to-balloon time at the PCI-performing hospital.Compared to direct emergency PCI treatment,it does not increase the risk of acute cardiac insufficiency,post-myocardial infarction ventricular remodeling,decline in cardiac function,or MACE events,nor does it reduce survival rates.