Mizuguchi Yukio, Shibutani Hiroki, Hashimoto Sho, Yamada Takeshi, Taniguchi Norimasa, Nakajima Shunsuke, Hata Tetsuya, Takahashi Akihiko
Cardiovascular Section, Sakurakai Takahashi Hospital, Hyogo, Japan.
Cardiovascular Section, Sakurakai Takahashi Hospital, Hyogo, Japan.
Indian Heart J. 2018 Jan-Feb;70(1):4-9. doi: 10.1016/j.ihj.2017.06.015. Epub 2017 Jun 30.
The various guidelines clearly mention the treatment strategies for in patient of acute myocardial infarction (MI) presenting more than 24h from symptom onset (recent myocardial infarction, RMI). However, the appropriate timing of reperfusion for RMI is unclear.
We retrospectively evaluated 525 consecutive MI patients who underwent percutaneous coronary intervention (PCI) in our hospital between January 2008 and December 2012.
Sixty RMI patients were more frequently associated with cardiac complications such as myocardial rupture (3.3% vs. 0%; p<0.01), ventricular septal rupture (3.3% vs. 0.4%; p<0.05), and congestive heart failure (15% vs. 2.6%; p<0.001) than 272 consecutive ST-elevation myocardial infarction (STEMI) patients. Of the 60 RMI patients, 33 (55.0%) underwent PCI within 7days (early-PCI group) and 27 (45.0%) underwent PCI after 7days (late-PCI group). Left ventricular ejection fraction measured by echocardiography at second hospital day was similar between the groups. The early-PCI group was more significantly associated with cardiogenic shock and heart failure and more frequently required intra-aortic balloon pumping (24.2% vs. 3.7%; p<0.05) than the late-PCI group. There were no significant differences in 30-day mortality, cardiac complications, and major cardiac events during long-term follow-up (12-36 months) between the groups.
RMI patients had a higher incidence of cardiac complications than AMI patients. Clinical outcomes were similar between patients undergoing early revascularization and those undergoing late revascularization, although the former group included a higher proportion of patients with severe cardiac failure.
各种指南明确提及了症状发作超过24小时的急性心肌梗死（MI，近期心肌梗死，RMI）住院患者的治疗策略。然而，RMI再灌注的合适时机尚不清楚。
我们回顾性评估了2008年1月至2012年12月期间在我院接受经皮冠状动脉介入治疗（PCI）的525例连续MI患者。
与272例连续的ST段抬高型心肌梗死（STEMI）患者相比，60例RMI患者更常出现心脏并发症，如心肌破裂（3.3%对0%；p<0.01）、室间隔破裂（3.3%对0.4%；p<0.05）和充血性心力衰竭（15%对2.6%；p<0.001）。在60例RMI患者中，33例（55.0%）在7天内接受了PCI（早期PCI组），27例（45.0%）在7天后接受了PCI（晚期PCI组）。两组在入院第二天通过超声心动图测量的左心室射血分数相似。早期PCI组比晚期PCI组更显著地与心源性休克和心力衰竭相关，且更频繁地需要主动脉内球囊反搏（2 . 42%对3.7%；p<0.05）。两组在30天死亡率、心脏并发症以及长期随访（12 - 36个月）期间的主要心脏事件方面无显著差异。
RMI患者心脏并发症的发生率高于AMI患者。早期血运重建患者和晚期血运重建患者的临床结局相似，尽管前一组中严重心力衰竭患者的比例更高。
