Song L, Deng S B, Guan C D, Liu C, Zhou P, Zhao H J, Xu B, Yan H B
Coronary Heart Disease Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
Department of Cardiology, Jingzhou First People's Hospital, Jingzhou 434000, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2020 Feb 24;48(2):118-122. doi: 10.3760/cma.j.issn.0253-3758.2020.02.006.
To compare the long-term outcomes in ST-elevation myocardial infarction (STEMI) patients who underwent early or late delayed percutaneous coronary intervention (PCI) using drug-eluting stents (DES). This study was a retrospective, observational and single-center study. Consecutive STEMI patients (977), who admitted to Fuwai Hospital in 2013 and underwent successful selective PCI using drug-eluting stents (DES) within 3 to 35 days after symptom onset were enrolled and divided into the early delayed PCI (3-14 d) group (495) and the late delayed PCI (15-35 d) group (482). General clinical data of the patients and related data of coronary angiography and interventional therapy were collected, and the endpoint events were followed up. The primary endpoint was 2-year major adverse cardiac and cerebrovascular events (MACCE) including cardiac death, recurrent myocardial infarction, definite or probable stent thrombosis and ischemic stroke. The secondary endpoint was 2-year ischemia-driven target vessel revascularization. The incidence of endpoint events of the two groups was compared, and it was compared again after the primary baseline characteristics such as age and gender were matched by the propensity scoring method at a 1∶1 ratio. A total of 910 (93.1%) patients who underwent delayed PCI were transferred from other hospitals, and 292 (29.9%) patients received thrombolysis before PCI. The time interval before PCI was 14 (10, 20) days. The incidence of 2-year MACCE (3.0%(15/495) vs. 2.3%(11/482), 0.468) and ischemia-driven target vessel revascularization (3.8%(19/495) vs. 5.0%(24/482), 0.385) were similar between the two groups. The incidence of 2-year MACCE (3.3%(15/453 vs. 2.4%(11/453), 0.426) and ischemia-driven target vessel revascularization (4.2% (19/453) vs. 4.9%(22/453), 0.632) were also similar between the two groups after matching propensity score. The long-term clinical outcomes after early delayed PCI using DES is statistically equivalent to those of late delayed PCI using DES for STEMI patients who missed the time window for emergency PCI.
比较接受早期或晚期延迟经皮冠状动脉介入治疗(PCI)并使用药物洗脱支架(DES)的ST段抬高型心肌梗死(STEMI)患者的长期结局。本研究为回顾性、观察性单中心研究。纳入2013年入住阜外医院、症状发作后3至35天内成功接受药物洗脱支架(DES)选择性PCI的连续STEMI患者(977例),分为早期延迟PCI组(3 - 14天)(495例)和晚期延迟PCI组(15 - 35天)(482例)。收集患者的一般临床资料以及冠状动脉造影和介入治疗的相关资料,并对终点事件进行随访。主要终点为2年主要不良心脑血管事件(MACCE),包括心源性死亡、再发心肌梗死、明确或可能的支架血栓形成以及缺血性卒中。次要终点为2年缺血驱动的靶血管血运重建。比较两组终点事件的发生率,并在按1∶1比例通过倾向评分法匹配年龄和性别等主要基线特征后再次进行比较。共有910例(93.1%)接受延迟PCI的患者从其他医院转入,292例(29.9%)患者在PCI前接受了溶栓治疗。PCI前的时间间隔为14(10,20)天。两组2年MACCE的发生率(3.0%(15/495)对2.3%(11/482),P = 0.468)和缺血驱动的靶血管血运重建的发生率(3.8%(19/495)对5.0%(24/482),P = 0.385)相似。倾向评分匹配后,两组2年MACCE的发生率(3.3%(15/453)对2.4%(11/453),P = 0.426)和缺血驱动的靶血管血运重建的发生率(4.2%(19/453)对4.9%(22/453),P = 0.632)也相似。对于错过急诊PCI时间窗的STEMI患者,早期延迟使用DES进行PCI后的长期临床结局在统计学上等同于晚期延迟使用DES进行PCI的患者。