急诊经皮冠状动脉介入治疗对合并院外心脏骤停的 ST 段抬高型心肌梗死患者结局的影响。

Impact of emergency percutaneous coronary intervention on outcomes of ST-segment elevation myocardial infarction patients complicated by out-of-hospital cardiac arrest.

机构信息

Coronary Care Unit, Division of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, China.

出版信息

Chin Med J (Engl). 2012 Apr;125(8):1405-9.

PMID:22613643

Abstract

BACKGROUND

Cardiac arrest is one of the most serious complications of acute myocardial infarction (AMI), especially in the out-of-hospital patients. There is no general consensus as to whether percutaneous coronary intervention (PCI) is effective in treating ST-segment elevation myocardial infarction (STEMI) patients complicated by out-of-hospital cardiac arrest (OHCA). In our study, we evaluated the efficacy of PCI in treating STEMI patients complicated by OHCA through observing their clinical conditions in hospital; including total mortality, adverse cardiac events, stroke, acute renal failure, and gastrointestinal bleeding events.

METHODS

A total of 1827 STEMI patients were enrolled in this study, where 81 were STEMI with OHCA. Between the patients with and without OHCA, and the OHCA patients with and without PCI, we compared the clinical characteristics during hospitalization, including total mortality and incidences of adverse cardiac events, and stroke.

RESULTS

Compared to the patients without OHCA, the OHCA patients had significantly lower systolic blood pressure (P < 0.05) and a faster heart rate (P < 0.05), and a higher percentage of Killip class IV or Glasgow coma scale (GCS) ≤ 7 on admission (P < 0.001). And the in-hospital mortality was higher in the OHCA patients (55.6% vs. 2.4%, P < 0.001). Comparing the OHCA patients without PCI to the patients with PCI, there was no obvious difference of heart rate, blood pressure or the percentage of Killip class IV and GCS ≤ 7 on admission, but the incidences of cardiogenic shock, stroke were significantly lower in the with-PCI group during hospitalization (P < 0.001, P < 0.05). And the in-hospital mortality of the OHCA patients receiving PCI was significantly lower (36.7% vs. 84.3%, P < 0.001).

CONCLUSIONS

During hospitalization, the incidence of adverse events and mortality are higher in the STEMI with OHCA patients, comparing with the STEMI without OHCA. Emergency PCI reduces the incidence of adverse events and decreases mortality during hospitalization, which is effective for treating STEMI with OHCA patients.

摘要

背景

心脏骤停是急性心肌梗死（AMI）最严重的并发症之一，尤其是在院外患者中。对于经皮冠状动脉介入治疗（PCI）是否对治疗伴有院外心脏骤停（OHCA）的 ST 段抬高型心肌梗死（STEMI）患者有效，目前尚无普遍共识。在我们的研究中，我们通过观察住院期间的临床情况来评估 PCI 治疗伴有 OHCA 的 STEMI 患者的疗效；包括总死亡率、不良心脏事件、卒中和急性肾功能衰竭以及胃肠道出血事件。

方法

共有 1827 例 STEMI 患者纳入本研究，其中 81 例为伴有 OHCA 的 STEMI。我们比较了伴有和不伴有 OHCA 的患者以及伴有和不伴有 PCI 的 OHCA 患者的住院期间临床特征，包括总死亡率和不良心脏事件、卒中等发生率。

结果

与不伴有 OHCA 的患者相比，OHCA 患者的收缩压明显较低（P < 0.05），心率较快（P < 0.05），入院时 Killip 分级 IV 级或格拉斯哥昏迷量表（GCS）≤ 7 的比例较高（P < 0.001）。OHCA 患者的住院期间死亡率更高（55.6%比 2.4%，P < 0.001）。与未接受 PCI 的 OHCA 患者相比，接受 PCI 的 OHCA 患者的心率、血压或入院时 Killip 分级 IV 级或 GCS≤ 7 的比例无明显差异，但住院期间心源休克和卒中的发生率明显较低（P < 0.001，P < 0.05）。接受 PCI 的 OHCA 患者的住院期间死亡率明显较低（36.7%比 84.3%，P < 0.001）。