De Luca Giuseppe, Suryapranata Harry, Zijlstra Felix, van 't Hof Arnoud W J, Hoorntje Jan C A, Gosselink A T Marcel, Dambrink Jan Henk, de Boer Menko Jan
Department of Cardiology, ISALA Klinieken, Hospital De Weezenlanden, Zwolle, The Netherlands.
J Am Coll Cardiol. 2003 Sep 17;42(6):991-7. doi: 10.1016/s0735-1097(03)00919-7.
The aim of the study was to evaluate the relationship between symptom-onset-to-balloon time and one-year mortality in patients with ST-segment elevation myocardial infarction (STEMI) treated by primary angioplasty.
Despite the prognostic implications demonstrated in patients with STEMI treated with thrombolysis, the impact of time-delay on prognosis in patients undergoing primary angioplasty has yet to be established.
Our study population consisted of 1,791 patients with STEMI treated by primary angioplasty from 1994 to 2001. All clinical, angiographic and follow-up data were collected. Subanalyses were conducted according to patient risk profile at presentation and preprocedural Thrombolysis In Myocardial Infarction (TIMI) flow.
A total of 103 patients (5.8%) had died at one year. Symptom-onset-to-balloon time was significantly associated with the rate of postprocedural TIMI 3 flow (p = 0.012), myocardial blush grade (p = 0.033), and one-year mortality (p = 0.02). A stronger linear association between symptom-onset-to-balloon time and one-year mortality was observed in non-low-risk patients (p = 0.006) and those with preprocedural TIMI flow 0 to 1 (p = 0.013). No relationship was found between door-to-balloon time and mortality. At multivariate analysis, a symptom-onset-to-balloon time >4 h was identified as an independent predictor of one-year mortality (p < 0.05).
This study shows that, in patients with STEMI treated by primary angioplasty, symptom-onset-to-balloon time, but not door-to-balloon time, is related to mortality, particularly in non-low-risk patients and in the absence of preprocedural anterograde flow. Furthermore, a symptom-onset-to-balloon time >4 h was identified as independent predictor of one-year mortality.
本研究旨在评估直接经皮冠状动脉腔内血管成形术（primary angioplasty）治疗的ST段抬高型心肌梗死（STEMI）患者症状发作至球囊扩张时间与一年死亡率之间的关系。
尽管溶栓治疗的STEMI患者已显示出预后意义，但直接经皮冠状动脉腔内血管成形术患者的时间延迟对预后的影响尚未确定。
我们的研究人群包括1994年至2001年接受直接经皮冠状动脉腔内血管成形术治疗的1791例STEMI患者。收集了所有临床、血管造影和随访数据。根据就诊时患者的风险特征和术前心肌梗死溶栓治疗（TIMI）血流情况进行亚组分析。
共有103例患者（5.8%）在一年时死亡。症状发作至球囊扩张时间与术后TIMI 3级血流率（p = 0.012）、心肌灌注分级（p = 0.033）和一年死亡率（p = 0.02）显著相关。在非低风险患者（p = 0.006）和术前TIMI血流为0至1级的患者（p = 0.013）中，症状发作至球囊扩张时间与一年死亡率之间观察到更强的线性关联。未发现门球时间与死亡率之间的关系。在多变量分析中，症状发作至球囊扩张时间>4小时被确定为一年死亡率的独立预测因素（p < 0.05）。
本研究表明，在直接经皮冠状动脉腔内血管成形术治疗的STEMI患者中，症状发作至球囊扩张时间而非门球时间与死亡率相关，特别是在非低风险患者以及术前无顺行血流的情况下。此外，症状发作至球囊扩张时间>4小时被确定为一年死亡率的独立预测因素。
