急性心肌梗死再灌注时机对患者预后的影响
급성심기경사재관주시궤대환자예후적영향
Influence of percutaneous coronary intervention timing on the prognosis of patients with acute ST segment elevation myocardial infarction
  • 万方数据
    中国心血管杂志 중국심혈관잡지
    CHINESE JOURNAL OF CARDIOVASOLOGY
    2014年 6期 413-417 ,共5页

    王军%华琦%李康%王丽%王云飞%李小明%薛淞%江大川%孔强%胡少东%张钰聪邵强%刘马超%赵霞%王姗%韩涛%金蔚英%王竞雄%李静%Li Jing

    왕군%화기%리강%왕려%왕운비%리소명%설송%강대천%공강%호소동%장옥총소강%류마초%조하%왕산%한도%금위영%왕경웅%리정%Li Jing

    心肌梗死%血管成形术,经腔,经皮冠状动脉%预后 心肌梗死%血管成形術,經腔,經皮冠狀動脈%預後
    심기경사%혈관성형술,경강,경피관상동맥%예후
    Myocardial infarction%Angioplasty,transluminal,percutaneous coronary%Prognosis
    目的：评价急性ST段抬高型心肌梗死( STEMI)患者接受直接经皮冠状动脉介入治疗时机对预后的影响。方法连续入选初发急性STEMI患者344例,按照急诊再灌注策略分为3组：未行急诊冠状动脉造影的患者110例为A组,发病至梗死相关血管开通时间在6 h之内的118例为B组,超过6 h而小于12 h的116例为C组,对3组患者临床资料、住院期间心血管事件以及长期预后进行比较。结果 A、B和C 3组患者血糖分别为(8.4±4.7) mmol/L、(7.7±3.3) mmol/L和(7.7±4.6)mmol/L (P=0.002)；血脂异常发生率分别为24.5﹪、5.9﹪和33.6﹪(P=0.008)；具有多重心血管危险因素(≥3个)的比例分别为25.5﹪、9.5﹪和43.1﹪( P =0.014)；冠状动脉单支病变(25.5﹪、46.9﹪和31.4﹪)、双支病变(33.6﹪、24.5﹪和33.3﹪)以及3支病变(40.9﹪、28.6﹪和35.3﹪)的比例差异有统计学意义(P=0.027)；住院期间主要不良心血管事件(MACE)发生率分别为12.7﹪、2.5﹪和12.9﹪(P=0.016)。经过36个月的随访,3组累积MACE发生率分别为20.9﹪、10.2﹪和23.3﹪(P=0.011)；Cox回归分析显示年龄、肌酐、入院时心率、前壁心肌梗死和发病至梗死相关血管开通时间＞6 h(RR：2.268,95％ CI：1.124~4.578,P=0.022)是MACE的独立危险因素。结论急性STEMI患者6 h以后开通梗死相关血管未能改善远期预后,应该采取更有效的措施保证其发病6h内接受再灌注治疗。
    목적：평개급성ST단태고형심기경사( STEMI)환자접수직접경피관상동맥개입치료시궤대예후적영향。방법련속입선초발급성STEMI환자344례,안조급진재관주책략분위3조：미행급진관상동맥조영적환자110례위A조,발병지경사상관혈관개통시간재6 h지내적118례위B조,초과6 h이소우12 h적116례위C조,대3조환자림상자료、주원기간심혈관사건이급장기예후진행비교。결과 A、B화C 3조환자혈당분별위(8.4±4.7) mmol/L、(7.7±3.3) mmol/L화(7.7±4.6)mmol/L (P=0.002)；혈지이상발생솔분별위24.5﹪、5.9﹪화33.6﹪(P=0.008)；구유다중심혈관위험인소(≥3개)적비례분별위25.5﹪、9.5﹪화43.1﹪( P =0.014)；관상동맥단지병변(25.5﹪、46.9﹪화31.4﹪)、쌍지병변(33.6﹪、24.5﹪화33.3﹪)이급3지병변(40.9﹪、28.6﹪화35.3﹪)적비례차이유통계학의의(P=0.027)；주원기간주요불양심혈관사건(MACE)발생솔분별위12.7﹪、2.5﹪화12.9﹪(P=0.016)。경과36개월적수방,3조루적MACE발생솔분별위20.9﹪、10.2﹪화23.3﹪(P=0.011)；Cox회귀분석현시년령、기항、입원시심솔、전벽심기경사화발병지경사상관혈관개통시간＞6 h(RR：2.268,95％ CI：1.124~4.578,P=0.022)시MACE적독립위험인소。결론급성STEMI환자6 h이후개통경사상관혈관미능개선원기예후,응해채취경유효적조시보증기발병6h내접수재관주치료。
    Objective To evaluate the influence of percutaneous coronary intervention ( PCI ) timing on prognosis of patients with acute ST segment elevation myocardial infarction (STEMI). Methods A total of 344 patients with STEMI were divided into three groups according to the reperfusion strategies:group A:(no emergent PCI, n=110),group B:(door to balloon time within 6 h after symptom onset, n=118) and group C (door to balloon time within 6-12 h after symptom onset, n=116). Clinical outcomes were compared among three groups. Results There was significant difference in clinical characteristics among group A,B and C, including blood glucose [(8. 4 ± 4. 7) mmol/L, (7. 7 ± 3. 3) mmol/L and (7. 7 ± 4. 6 ) mmol/L, respectively, P = 0. 002 ] , hyperlipidemia history ( 24. 5﹪, 5. 9﹪ and 33. 6﹪, respectively, P = 0. 008 ) , ≥3 risk factors of cardiovascular disease ( 25. 5﹪, 9. 5﹪ and 43. 1﹪,respectively, P = 0. 014 ) and lesion number ( P = 0. 027 ) . In-hospital incidence of major adverse cardiovascular events ( MACE) was 12. 7﹪ in group A, 2. 5﹪ in group B and 12. 9﹪ in group C ( P=0. 016). Cumulative incidence of MACE in three groups was 20. 9﹪, 10. 2﹪ and 23. 3﹪ ( P=0. 011) during follow up. In cox proportional hazards regression model, age, creatinine, heart rate, PCI time >6 h (RR:2. 268, 95% CI:1. 124_4. 578,P=0. 022) and anterior wall myocardial infarction were independent predictors for MACE during 36 months follow up. Conclusions In patients with STEMI, there is no obvious benefits from reopening of culprit artery 6 hours after symptom onset. Therefore, it is crucial to perform reperfusion therapy with 6 h.
    원문보기 원문다운로드 사이트로이동
저자의 최근 논문