aInterventional Cardiology Unit, San Luigi Gonzaga University Hospital, Orbassano and Rivoli Hospital, Rivoli (Turin) bDivision of Cardiology, Maria Vittoria Hospital, Turin, Italy.
J Cardiovasc Med (Hagerstown). 2017 Aug;18(8):567-571. doi: 10.2459/JCM.0000000000000527.
Patients with delayed presentation of acute myocardial infarction with ST-segment elevation (STEMI) frequently have a poor prognosis but literature about acute complications in intensive cardiac care unit (ICCU) and in-hospital outcome are still limited.
All STEMI patients admitted to our institution between June 2007 and December 2013 were divided into patients presenting more than 12 h after symptom onset (lateSTEMI) and within 12 h (STEMI). Baselines clinical features including details about treatment of choice were collected. Major acute complications in ICCU and in-hospital mortality were the main end-points.
A total of 1372 patients were included, 147 (10.8%) were lateSTEMI. In ICCU lateSTEMI patients compared with STEMI patients experienced more frequently heart failure (75, 51.2% vs. 298, 24.3%; P < 0.001), atrial fibrillation (26, 17.7% vs. 130, 10.6%; P = 0.011), complete atrioventricular block (16, 10.9% vs. 63, 5.1%; P = 0.005), stroke (5, 3.4% vs. 5, 0.4%; P < 0.001), myocardial rupture (6, 4.1% vs. 3, 0.2%; P < 0.001), with higher administration of noninvasive ventilation support therapy (13, 9.8% vs. 44, 3.6%; P = 0.001) and the intra-aortic balloon counter-pulsation use (14, 10.3% vs. 102, 8.3%; P = 0.038). Intrahospital mortality was significantly higher in the lateSTEMI group (19, 13.4% vs. 69, 5.6%; P = 0.001). At the multiple regression analysis age [odds ratio (OR) 2.2 (1.46-2.92.; P = 0.01)], diabetes [OR 2.37 (1.38-4.07); P = 0.002] intra-aortic balloon counter-pulsation implantation [OR 2.78 (1.30-5.9); P = 0.03] and late presentation more than 12 h [2.52 (1.35-4.69); P = 0.001] resulted independently correlated with in-hospital mortality while a successful percutaneous coronary intervention procedure was protective [OR 0.15 (0.08-0.27); P = 0.003; all 95% confidence interval).
Late presenters STEMI patients present a worse risk profile and prognosis compared with patients who arrive less than 12 h from onset of symptoms. Because of the presence of serious complications such as heart rupture or stroke a careful clinic and echocardiographic monitoring is strongly advisable in these population.
ST 段抬高型急性心肌梗死（STEMI）患者延迟就诊，其预后通常较差，但关于重症监护病房（ICCU）内和院内的急性并发症以及院内转归的文献仍然有限。
将 2007 年 6 月至 2013 年 12 月期间我院收治的所有 STEMI 患者分为发病后 12 小时以上就诊（晚期 STEMI）和发病 12 小时内就诊（STEMI）的患者。收集基线临床特征，包括选择治疗的详细信息。主要的 ICU 内急性并发症和院内死亡率为主要终点。
共纳入 1372 例患者，其中 147 例（10.8%）为晚期 STEMI。与 STEMI 患者相比，ICCU 中的晚期 STEMI 患者更频繁地发生心力衰竭（75 例，51.2%比 298 例，24.3%；P＜0.001）、心房颤动（26 例，17.7%比 130 例，10.6%；P=0.011）、完全性房室传导阻滞（16 例，10.9%比 63 例，5.1%；P=0.005）、中风（5 例，3.4%比 5 例，0.4%；P＜0.001）、心肌破裂（6 例，4.1%比 3 例，0.2%；P＜0.001），接受非侵入性通气支持治疗（13 例，9.8%比 44 例，3.6%；P=0.001）和主动脉内球囊反搏术（14 例，10.3%比 102 例，8.3%；P=0.038）的比例更高。晚期 STEMI 组院内死亡率明显较高（19 例，13.4%比 69 例，5.6%；P=0.001）。在多变量回归分析中，年龄[比值比（OR）2.2（1.46-2.92；P=0.01）]、糖尿病[OR 2.37（1.38-4.07）；P=0.002]、主动脉内球囊反搏术植入[OR 2.78（1.30-5.9）；P=0.03]和就诊超过 12 小时[OR 2.52（1.35-4.69）；P=0.001]与院内死亡率独立相关，而经皮冠状动脉介入治疗术是保护性的[OR 0.15（0.08-0.27）；P=0.003；所有 95%置信区间]。
与症状发作后就诊时间少于 12 小时的患者相比，延迟就诊的 STEMI 患者的风险特征和预后更差。由于存在严重并发症，如心脏破裂或中风，因此强烈建议对这些患者进行仔细的临床和超声心动图监测。
