Zhang Yu-Jiao, Zheng Wen, Sun Jian, Li Guo-Li, Chi Bao-Rong
Department of Cardiology, the First Hospital of Jilin University, Changchun, China.
Department of Cardiology, the First Hospital of Jilin University, Changchun, China.
J Electrocardiol. 2015 Mar-Apr;48(2):260-7. doi: 10.1016/j.jelectrocard.2015.01.004. Epub 2015 Jan 6.
The clinical benefit of percutaneous coronary intervention (PCI) is controversial in ST-segment elevation myocardial infarction (STEMI) patients presenting 12-72 hours after symptom onset. Several studies suggested this conflicting result was associated with myocardial area at risk (MaR) of enrolled patients. MaR could be estimated by the electrocardiogram (ECG) score. Our objective was to evaluate the benefits of PCI in STEMI latecomers with different MaR.
We constructed a prospective cohort involving 436 patients presenting 12-72 hours after STEMI onset and who met an inclusion criteria. 218 underwent PCI and 218 received the optimal medical therapy (OMT) alone. Individual MaR was quantified by the combined Aldrich ST and Selvester QRS score. The primary endpoint was a composite of cardiovascular death, reinfarction or revascularization within two years.
The 2-year cumulative primary endpoint rate was respectively 9.2% in PCI group and 5.3% in OMT group when MaR<35% (adjusted hazard ratio for PCI vs. OMT, 1.855; 95% confidence interval [CI], 0.617-5.575; P=0.271), and was 12.8% in PCI group and 23.1% in OMT group when MaR ≥35% (adjusted hazard ratio for PCI vs. OMT, 0.448; 95% CI, 0.228-0.884; P=0.021).
The benefit of PCI for the STEMI latecomers was associated with the MaR. PCI, compared with OMT, could significantly reduce the 2-year primary outcomes in patients with MaR≥35%, but not in ones with MaR<35%.
对于症状发作12至72小时后就诊的ST段抬高型心肌梗死（STEMI）患者，经皮冠状动脉介入治疗（PCI）的临床获益存在争议。多项研究表明，这一相互矛盾的结果与入组患者的心肌梗死危险区（MaR）有关。MaR可通过心电图（ECG）评分来估计。我们的目的是评估不同MaR的STEMI延迟就诊患者接受PCI的获益情况。
我们构建了一个前瞻性队列，纳入436例STEMI发作12至72小时后就诊且符合纳入标准的患者。218例接受了PCI，218例仅接受了最佳药物治疗（OMT）。通过Aldrich ST和Selvester QRS评分联合对个体MaR进行量化。主要终点是两年内心血管死亡、再梗死或血运重建的复合终点。
当MaR<35%时，PCI组的2年累积主要终点发生率为9.2%，OMT组为5.3%（PCI对比OMT的调整后风险比为1.855；95%置信区间[CI]为0.617 - 5.575；P = 0.271）；当MaR≥35%时，PCI组为12.8%，OMT组为23.1%（PCI对比OMT的调整后风险比为0.448；95%CI为0.228 - 0.884；P = 0.021）。
STEMI延迟就诊患者接受PCI的获益与MaR有关。与OMT相比，PCI可显著降低MaR≥35%患者的2年主要结局，但对MaR<35%的患者则不然。
