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目的:观察急诊经皮冠状动脉介入术(PCI)开通梗死相关血管的时程变化对急性ST段抬高型心肌梗死(STEMI)住院期间死亡率及心肌梗死后30 d内心血管事件发生率的影响。方法:急性STEMI患者213例,根据症状发生至第1次球囊扩张的时间分为3组:<180 min组(A组,27例),180～360 min组(B组,83例),>360 min组(C组,103例)。观察各组术后30 d内主要心血管不良事件的发生率,包括心源性死亡、非致死性心肌梗死、急性亚急性支架内血栓形成。结果:症状发生到第1次球囊扩张的时间中位数为(355.3±223)min,C组老年患者(≥75岁)及女性患者相对多见,前壁梗死和心源性休克发生率较高。住院总心源性死亡率为13.6%,C组住院期间死亡率(17.5%)明显高于A组(3.7%)和B组(12.1%);急性心肌梗死的并发症心源性休克显著影响死亡率(36.5%)。随访30 d,心源性休克、≥75岁高龄、女性患者心血管事件发生率显著升高。多因素回归分析显示时间延迟>360 min是影响急性STEMI早期预后的独立危险因素。结论:急诊PCI时间的延迟显著影响急性STEMI早期预后。急诊PCI时间延迟超过6h是影响早期预后的独立危险因素。
Aims: To observe the changes of the time course of infarction-related vascular changes in emergency percutaneous coronary intervention (PCI) during hospitalization and the incidence of cardiovascular events within 30 days after acute ST-segment elevation myocardial infarction (STEMI) . Methods: A total of 213 acute STEMI patients were divided into three groups according to their symptoms until the first balloon dilatation: 180 min (group A, n = 27), 180 min to 360 min (group B, 83) > 360 min group (C group, 103 cases). The incidence of major cardiovascular adverse events within 30 days after operation was observed, including cardiogenic death, non-fatal myocardial infarction and acute subacute stent thrombosis. Results: The median time to first balloon dilation was (355.3 ± 223) min. The incidence of anterior wall infarction and cardiogenic shock was higher in elderly patients (≥75 years) and female patients in group C Higher. The total hospital mortality was 13.6%. The hospitalization mortality rate in group C (17.5%) was significantly higher than that in group A (3.7%) and group B (12.1%). Complications of acute myocardial infarction were significantly affected by cardiogenic shock Mortality (36.5%). After 30 days of follow-up, cardiogenic shock, ≥75 years of age, the incidence of cardiovascular events in female patients was significantly increased. Multivariate regression analysis showed that time delay> 360 min was an independent risk factor for early prognosis of acute STEMI. Conclusion: The delay of emergency PCI significantly affects the early prognosis of acute STEMI. Emergency PCI time delay more than 6h is an independent risk factor for early prognosis.