急性心肌梗死血管介入治疗时间与左室射血分数、肌酸磷酸激酶同工酶的关系

Relationship of symptom-onset-to-balloon time and symptom-onset-to-lab time with LVEF and CK-MB in patients with acute myocardial infarction undergoing emergent angioplasty

目的 通过分析急性心肌梗死症状发作 球囊扩张时间 (symptom onset to balloon ,SOTB)和症状发作 进导管室时间 (symptom onset to lab ,SOTL)与左室射血分数 (LVEF)和肌酸磷酸激酶同工酶(CK MB)的关系 ,探讨如何进一步完善急性心肌梗死绿色通道的运转机制。方法 入选 2 0 0 1年 1月 1日至2 0 0 2年 7月 31日来院的ST段抬高的急性心肌梗死患者 ,发病时间在 12h内 ,行急诊冠状动脉造影和急诊经皮冠状动脉介入 (PCI) ,并观察住院期间的LVEF和CK MB的峰值浓度。结果 急性心肌梗死患者入选394例行急诊冠脉造影 ,男 314例 ,女 80例 ,年龄 (6 1± 2 )岁。只进行急诊冠状动脉造影 78例 ,行急诊PCI的有 316例 ,其中直接PCI的为 30 6例 ,溶栓后未通行补救性PCI的有 10例。平均SOTB为 (2 77 7±15 9 3)min ,SOTL为 (2 5 7 2± 16 3 9)min。SOTB≥ 36 0min组与 <36 0min组的LVEF分别为 (5 8 2± 11 1) %和 (6 0 1± 17 5 ) % (P =0 0 0 5 ) ,CK MB的峰值浓度分别为 (14 1 4± 14 7 4 )U/L和 (10 0 7± 75 6 )U/L (P=0 0 0 0 )。SOTL≥ 30 0min组与 <30 0min组的LVEF分别为 (5 8 3± 11 2 ) %和 (6 0 1± 16 2 ) % (P =0 0 15 ) ,CK MB的峰值浓度分别为 (12 7 3± 134 0 )U/L和 (10 1 0± 75 9)U/L

Objective To discuss how to perfect the operating system of 'Ready Access'for acute myocardial infarction by analyzing the relationship of symptom onset to balloon(SOTB) time and symptom onset to lab(SOTL)time with LVEF and CK MB in patients with acute myocardial infarction undergoing emergent angioplasty.Methods 394 consecutive patients with acute myocardial infarction associated with ST segment elevation and SOTD within 12 hours between January 2001 and July 2002 were treated with emergent coronary angiography and angioplasty.The relation of SOTB and SOTL with LVEF and the peak concentration of CK MB was analyzed.Results Average SOTB was (277 7±159 3)min,SOTL was (257 2±163 9)min.The LVEF of group SOTB≥360 min and group<360 min were (58 2±11 1)% and (60 1±17 5)% respectively( P =0 005),and the peak concentration of CK MB were(141 4±147 4)U/L and (100 7±75 6)U/L respectively ( P =0 000).The LVEF of group SOTL≥300 min and group<300 min were (58 3±11 2)% and (60 1±16 2)% ( P =0 015),and the peak concentration of CK MB were (127 3±134 0)U/L and (101 0±75 9)U/L respectively( P =0 008).Conclusion To shorten SOTB and SOTL can improve LVEF and decrease the reak concentration of CK MB in patients with acute myocardial infarction.