Ho Yuan-Chih, Tsai Tzu-Hsien, Sung Pei-Hsun, Chen Yung-Lung, Chung Sheng-Ying, Yang Cheng-Hsu, Chen Shyh-Ming, Chen Chien-Jen, Fang Hsiu-Yu, Wu Chiung-Jen, Yip Hon-Kan
1Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. 2Center for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan. 3Institute of Shock Wave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Crit Care Med. 2014 Aug;42(8):1788-96. doi: 10.1097/CCM.0000000000000329.
We tested the hypothesis that, as compared with conventional door-to-balloon, shortened door-to-balloon time would further improve 30-day outcome in ST-elevation myocardial infarction patients undergoing primary stenting.
Retrospective cohort study
Academic tertiary care hospital with approximately 2600 beds
Between January 2008 and December 2009, 266 ST-elevation myocardial infarction patients underwent primary stenting with conventional Door-to-baloon were consecutively enrolled as group 1, while 293 ST-elevation myocardial infarction patients underwent primary stenting with shortened door-to-balloon between January 2010 and December 2011 were consecutively enrolled as group 2.
Shorten door-to-balloon time.
The results showed that time from chest pain onset to door did not differ between two groups (p > 0.1), whereas door-to-balloon time was significantly reduced in group 2 compared with that in group 1 (p < 0.0001). The prevalences of successful reperfusion, acute and subacute stent thrombosis, 30-day death or combined endpoint (defined as congestive heart failure ≥ New York Heart Association functional class 3 or 30-d death), and left ventricular function did not differ between two groups (all p > 0.05), whereas the peak creatine phosphokinase level was significantly reduced in group 2 (< 0.05). Further analysis showed that shortening the chest pain-to-reperfusion time to less than 240 minutes was the most important factor in improving left ventricular function (p < 0.001) and 30-day combined endpoint. Multivariate analysis showed that congestive heart failure greater than or equal to New York Heart Association functional class 3, poor left ventricular function, and age (all p < 0.001) along with unsuccessful reperfusion (p = 0.25) were independently predictive of 30-day mortality.
Shortening the duration between chest pain onset and reperfusion to less than 4.0 hours was critical in reducing myocardial necrosis and improving heart function and 30-day mortality.
我们检验了如下假设，即与传统的门球时间相比，缩短门球时间会进一步改善接受直接支架植入术的ST段抬高型心肌梗死患者的30天预后。
回顾性队列研究
拥有约2600张床位的学术性三级医疗机构
在2008年1月至2009年12月期间，266例接受传统门球时间直接支架植入术的ST段抬高型心肌梗死患者连续入选为第1组，而在2010年1月至2011年12月期间，293例接受缩短门球时间直接支架植入术的ST段抬高型心肌梗死患者连续入选为第2组。
缩短门球时间。
结果显示，两组患者从胸痛发作到入院的时间无差异（p>0.1），而第2组的门球时间与第1组相比显著缩短（p<0.0001）。两组患者的成功再灌注率、急性和亚急性支架血栓形成率、30天死亡率或联合终点事件（定义为充血性心力衰竭≥纽约心脏协会心功能分级3级或30天死亡）以及左心室功能无差异（所有p>0.05），而第2组的肌酸磷酸激酶峰值水平显著降低（<0.05）。进一步分析表明，将胸痛至再灌注时间缩短至小于240分钟是改善左心室功能（p<0.001）和30天联合终点事件的最重要因素。多因素分析显示，充血性心力衰竭≥纽约心脏协会心功能分级3级、左心室功能差和年龄（所有p<0.001）以及再灌注不成功（p=0.25）是30天死亡率的独立预测因素。
将胸痛发作至再灌注的持续时间缩短至小于4.0小时对于减少心肌坏死、改善心脏功能和30天死亡率至关重要。
