缩短入门-球囊扩张时间对ST段抬高型心肌梗死患者时间指标及预后的影响
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(1. 河北医科大学研究生学院,河北省石家庄市 050017;2.河北省人民医院心血管内一科,河北省石家庄市 050051;3.华北理工大学研究生学院,河北省唐山市 063210)

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刘璇,硕士研究生,研究方向为冠心病,E-mail为liuxuan3026@foxmail.com。通信作者李树仁,博士,主任医师,研究方向为心血管基础与临床,E-mail为lsr64@126.com。

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Effect of improved door-to-balloon time on time indices and outcomes of patients with ST-segment elevation myocardial infarction
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1.Graduate College, Hebei Medical University, Shijiazhuang, Hebei 050017, China;2.Department of Cardiology, Hebei General Hospital, Shijiazhuang, Hebei 050051, China;3.College of Graduate School, North China University of Science and Technology, Tangshan, Hebei 063210, China)

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    摘要:

    目的 探讨缩短入门-球囊扩张(D2B)时间是否有利于改善首诊于非PCI医院的急性ST段抬高型心肌梗死(STEMI)患者预后。方法 入选发病时间小于12 h的STEMI患者200例,记录D2B时间、首次医疗接触-球囊扩张(FMC2B)时间及症状-球囊扩张(S2B)时间。根据D2B时间将患者分为D2B<60组148例和D2B≥60组52例。比较两组首次医疗接触-球囊扩张(FMC2B)和发病-球囊扩张(S2B)时间。随访观察两组主要不良心脑血管事件(MACCE)(包括心原性死亡、非致死性心肌梗死、非致死性卒中、因不稳定型心绞痛或心力衰竭再入院)和全因死亡的情况。采用多因素Cox回归模型分析D2B时间与MACCE发生的关系。结果 D2B<60组FMC2B时间及S2B时间较D2B≥60组短(P=0.013;P=0.027)。与D2B≥60组相比,D2B<60组患者MACCE发生率及全因死亡率减低(P=0.008;P=0.047)。Cox回归分析发现,D2B时间<60 min与MACCE发生相关(HR 0.440,95%CI 0.224~0.862, P=0.017)。结论 对于首诊于非PCI医院的STEMI患者,控制D2B时间<60 min可以减少S2B时间,降低MACCE发生率及全因死亡率。

    Abstract:

    Aim To investigate the effect of improved door-to-balloon (D2B) time on outcomes in patients diagnosed with ST-segment elevation myocardial infarction (STEMI) in non percutaneous coronary intervention (PCI) centers. Methods A total of 200 STEMI patients within 12 h presenting were enrolled. D2B time, first medical contact-to-balloon (FMC2B) time and symptom-to-balloon (S2B) time were recorded. According to D2B time, all patients were divided into D2B<60 group (n=148) and D2B≥60 group (n=52). FMC2B time and S2B time were compared between the two groups. Major adverse cardiac and cerebral events (MACCE, including cardiogenic death, non-fatal myocardial infarction, non-fatal stroke, re-admission of unstable angina or heart failure) and all-cause mortality during follow-up of two groups were observed. Cox regression analysis was used to explore the association of D2B time and MACCE. Results D2B<60 group had shorter FMC2B time and S2B time than D2B≥60 group (P=0.013; P=0.027). Compared to D2B≥60 group, D2B<60 group had lower MACCE and all-cause mortality (P=0.008; P=0.047). Cox regression analysis showed that a D2B time less than 60min was an independent factor associated of MACCE (HR 0.0,5%CI 0.224~0.862, P=0.017). Conclusion A D2B time less than 60min can shorten symptom-to-balloon time and improve MACCE and all-cause mortality in STEMI patients not presenting in PCI center.

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刘璇,李树仁,杨国慧,郝潇,郑梅.缩短入门-球囊扩张时间对ST段抬高型心肌梗死患者时间指标及预后的影响[J].中国动脉硬化杂志,2019,27(7):615~618.

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  • 收稿日期:2018-11-17
  • 最后修改日期:2019-04-21
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  • 在线发布日期: 2019-06-04