Wang Nan, Zhang Min, Su Huajun, Huang Zhonglue, Lin Yongbo, Zhang Min
Department of Otolaryngology-Head and Neck Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Cardiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
J Int Med Res. 2020 Oct;48(10):300060520966151. doi: 10.1177/0300060520966151.
No data are available to develop uniform recommendations for reperfusion therapies in ST-segment elevation myocardial infarction (STEMI) during the coronavirus disease 2019 (COVID-19) pandemic. We aimed to fill the evidence gap regarding STEMI reperfusion strategy during the COVID-19 era.
Clinical characteristics and outcomes for 17 patients with STEMI who received fibrinolysis during the COVID-19 pandemic were compared with 20 patients who received primary percutaneous coronary intervention (PPCI), and were further compared with another 41 patients who received PPCI in the pre-COVID-19 period.
In patients with STEMI, fibrinolysis achieved a comparable in-hospital and 30-day primary composite end point, as compared with those who received PPCI during the COVID-19 pandemic. No major bleeding was detected in either group. Compared patients with STEMI who received PPCI in the pre-COVID-19 period, we found a remarkable extension of chest pain onset-to-first medical contact (FMC) and FMC-to-wire crossing times, significantly increased number and length of stents, and much worse thrombolysis in myocardial infarction flow in patients with STEMI who received PPCI during the COVID-19 pandemic.
Owing to its considerable efficacy and safety and advantages in conserving medical resources, we recommend fibrinolysis as a reasonable alternative for STEMI care during the COVID-19 pandemic.
在2019冠状病毒病（COVID-19）大流行期间，尚无数据可用于制定ST段抬高型心肌梗死（STEMI）再灌注治疗的统一建议。我们旨在填补COVID-19时代关于STEMI再灌注策略的证据空白。
将17例在COVID-19大流行期间接受溶栓治疗的STEMI患者的临床特征和结局与20例接受直接经皮冠状动脉介入治疗（PPCI）的患者进行比较，并进一步与另外41例在COVID-19大流行前接受PPCI的患者进行比较。
在STEMI患者中，与在COVID-19大流行期间接受PPCI的患者相比，溶栓治疗在院内和30天主要复合终点方面取得了相当的效果。两组均未检测到严重出血。与在COVID-19大流行前接受PPCI的STEMI患者相比，我们发现胸痛发作至首次医疗接触（FMC）和FMC至导丝通过时间显著延长，支架数量和长度显著增加，且在COVID-19大流行期间接受PPCI的STEMI患者中，心肌梗死溶栓血流情况更差。
由于溶栓治疗具有相当的疗效和安全性以及在节约医疗资源方面的优势，我们建议在COVID-19大流行期间，溶栓治疗作为STEMI治疗的合理替代方案。
