Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
PLoS One. 2020 Oct 22;15(10):e0241251. doi: 10.1371/journal.pone.0241251. eCollection 2020.
Recent guidelines for ST-elevation myocardial infarction (STEMI) recommended the door-to-balloon time (DTBT) <90 minutes. However, some patients could have poor clinical outcomes in spite of DTBT <90 minutes, which suggest the importance of therapeutic targets except DTBT. The purpose of this study was to find factors associated with poor clinical outcomes in STEMI patients with DTBT <90 minutes.
This retrospective study included 383 STEMI patients with DTBT <90 minutes. The primary endpoint was the major adverse cardiac events (MACE) defined as the composite of all-cause death, acute myocardial infarction, and acute heart failure requiring hospitalization.
The median follow-up duration was 281 days, and the cumulative incidence of MACE was 16.2%. In the multivariate Cox hazard model, low body mass index (< 20 kg/m2) (vs. >20 kg/m2: HR 2.80, 95% CI 1.39-5.64, p = 0.004), history of previous myocardial infarction (HR 2.39, 95% CI 1.06-5.37, p = 0.04), and Killip class 3 or 4 (vs. Killip class 1 or 2: HR 2.39, 95% CI 1.30-4.40, p = 0.005) were significantly associated with MACE. In another multivariate Cox hazard model, flow worsening during percutaneous coronary intervention (PCI) (HR 3.24, 95% CI 1.79-5.86, p<0.001) and use of mechanical support (HR 3.15, 95% CI 1.71-5.79, p<0.001) were significantly associated with MACE, whereas radial approach (HR 0.54, 95% CI 0.32-0.92, p = 0.02) was inversely associated with MACE.
Low body mass index, Killip class 3/4, history of previous myocardial infarction, use of mechanical support, and flow worsening were significantly associated with MACE, whereas radial-access was inversely associated with MACE. It is important to avoid flow worsening during primary PCI even when appropriate DTBT was achieved.
最近 ST 段抬高型心肌梗死（STEMI）的指南建议门球时间（DTBT）<90 分钟。然而，尽管 DTBT<90 分钟，一些患者仍可能出现不良临床结局，这表明除 DTBT 外，治疗目标也很重要。本研究的目的是寻找与 DTBT<90 分钟的 STEMI 患者不良临床结局相关的因素。
本回顾性研究纳入了 383 例 DTBT<90 分钟的 STEMI 患者。主要终点是主要不良心脏事件（MACE），定义为全因死亡、急性心肌梗死和需要住院治疗的急性心力衰竭的复合终点。
中位随访时间为 281 天，MACE 的累积发生率为 16.2%。多变量 Cox 风险模型中，低体重指数（<20kg/m2）（与>20kg/m2 相比：HR 2.80，95%CI 1.39-5.64，p=0.004）、既往心肌梗死史（HR 2.39，95%CI 1.06-5.37，p=0.04）和 Killip 分级 3 或 4 级（与 Killip 分级 1 或 2 级相比：HR 2.39，95%CI 1.30-4.40，p=0.005）与 MACE 显著相关。在另一项多变量 Cox 风险模型中，经皮冠状动脉介入治疗（PCI）期间血流恶化（HR 3.24，95%CI 1.79-5.86，p<0.001）和使用机械支持（HR 3.15，95%CI 1.71-5.79，p<0.001）与 MACE 显著相关，而桡动脉入路（HR 0.54，95%CI 0.32-0.92，p=0.02）与 MACE 呈负相关。
低体重指数、Killip 分级 3/4 级、既往心肌梗死史、使用机械支持和血流恶化与 MACE 显著相关，而桡动脉入路与 MACE 呈负相关。即使达到了适当的 DTBT，在进行直接 PCI 时也应避免血流恶化。
