Lachance Philippe, Déry Jean-Pierre, Beaudoin Jonathan, Barbeau G Erald, Noël Bernard, Bertrand Olivier F, Rodés-Cabau Josep, Nguyen Can M, Proulx Guy, Gleeton Onil, Larose Eric, Roy Louis, Delarochelliére Robert
Cardiology Department, Laval Hospital, Québec, Canada.
J Invasive Cardiol. 2008 Nov;20(11):623-6.
In ST-segment elevation acute myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI), all efforts must be made to improve door-to-balloon (DTB) times. This study was designed to assess the impact of electrocardiographic-guided immediate intervention (EGII) without performing a complete coronary evaluation on DTB times and clinical outcomes of STEMI patients treated with primary PCI.
Consecutive STEMI patients undergoing primary PCI at Laval Hospital between May 2006 and August 2007 were considered for inclusion. Patients with thrombolysis in myocardial infarction (TIMI) 2-3 flow in the culprit vessel on initial angiography and patients with previous coronary bypass surgery were excluded from the analysis. The primary evaluation was DTB time. Clinical outcomes consisted of cardiac death, reinfarction, revascularization or stroke.
Two hundred seventy-nine (279) patients were included in the present analysis. Eighty-seven (87) patients underwent EGII (Group 1) and 192 underwent PCI after a complete angiographic diagnostic evaluation (Group 2). Median catheterization laboratory DTB was 21 minutes in Group 1 and 25.5 minutes in Group 2 (p < 0.0001). The median DTB time was 80 minutes for patients in Group 1, compared to 90 minutes for patients in Group 2 (p = 0.01). More patients in Group 1 received timely reperfusion (DTB < 90 min) than patients in Group 2 (63% vs. 49%; p = 0.04). There was a trend towards reduced mortality in Group 1 compared to Group 2 (p = 0.11, unadjusted).
A strategy of EGII reduces DTB times with a possible impact on clinical outcomes in STEMI patients undergoing primary PCI.
在接受直接经皮冠状动脉介入治疗（PCI）的ST段抬高型急性心肌梗死（STEMI）患者中，必须尽一切努力缩短门球时间（DTB）。本研究旨在评估在不进行完整冠状动脉评估的情况下，心电图引导下的即刻干预（EGII）对接受直接PCI治疗的STEMI患者的DTB时间和临床结局的影响。
纳入2006年5月至2007年8月在拉瓦尔医院接受直接PCI的连续STEMI患者。初始血管造影时罪犯血管心肌梗死溶栓（TIMI）血流为2 - 3级的患者以及既往有冠状动脉搭桥手术史的患者被排除在分析之外。主要评估指标为DTB时间。临床结局包括心源性死亡、再梗死、血管重建或卒中。
本分析纳入了279例患者。87例患者接受了EGII（第1组），192例患者在完成血管造影诊断评估后接受了PCI（第2组）。第1组导管室DTB中位数为21分钟，第2组为25.5分钟（p < 0.0001）。第1组患者DTB时间中位数为80分钟，第2组为90分钟（p = 0.01）。第1组中接受及时再灌注（DTB < 90分钟）的患者比第2组更多（63%对49%；p = 0.04）。与第2组相比，第1组有死亡率降低的趋势（p = 0.11，未校正）。
EGII策略可缩短DTB时间，可能对接受直接PCI的STEMI患者的临床结局产生影响。
