Nan Jing, Meng Shuai, Hu Hongyu, Jia Ruofei, Jin Zening
Department of Cardiology and Macrovascular Disease, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
Int J Gen Med. 2021 Jan 19;14:201-209. doi: 10.2147/IJGM.S292901. eCollection 2021.
The efficacy of fibrinolysis therapy with deferred percutaneous coronary angioplasty (FPCI) versus primary angioplasty (PPCI) during the coronavirus disease 2019 (COVID-19) pandemic is unclear when medical quarantine is needed.
Acute ST segment elevation myocardial infarction (STEMI) patients underwent PPCI after finishing the screening protocol from January 23, 2020 to June 10, 2020 while FPCI was applied when COVID-19-confirmed cases reoccurred in Beijing near our hospital from June 11, 2020 to July 20, 2020. The door-to-balloon time (DTB) or door-to-needle time (DTN) as well as in-hospital adverse clinical outcomes were compared between the two groups. A propensity score-matched (PSM) analysis was performed to diminish the potential influence of confounding factors on the clinical outcomes.
A total of 126 STEMI patients underwent PPCI after finishing the screening protocol and 17 patients received FPCI before PSM. Patients who received FPCI were younger than patients who underwent PPCI (50.8±14.0 versus 64.1±14.2 years, p=0.001), and chronic kidney disease (CKD) was less common in FPCI patients than in patients who underwent PPCI (0% versus 24.6%, p=0.024). The DTN was significantly shorter than DTB (25.8±4.2 versus 61.1±10.7, p=0.000) before PSM. The DTN was significantly shorter than DTB (26.9±4.2 versus 64.9±23.6, p=0.000); however, the incidence rate of in-hospital ischemia and bleeding adverse clinical outcomes were comparable between the two groups after PSM.
Fibrinolysis therapy combined with deferred PCI can reduce the ischemia time and has a similar in-hospital adverse clinical outcome rate compared with patients who underwent primary PCI during the COVID-19 pandemic.
在2019年冠状病毒病（COVID-19）大流行期间，当需要医学隔离时，延迟经皮冠状动脉介入治疗（FPCI）与直接经皮冠状动脉介入治疗（PPCI）的溶栓治疗效果尚不清楚。
2020年1月23日至2020年6月10日，急性ST段抬高型心肌梗死（STEMI）患者在完成筛查方案后接受PPCI，而在2020年6月11日至2020年7月20日我院附近北京出现COVID-19确诊病例时应用FPCI。比较两组的门球时间（DTB）或门针时间（DTN）以及院内不良临床结局。进行倾向评分匹配（PSM）分析以减少混杂因素对临床结局的潜在影响。
共有126例STEMI患者在完成筛查方案后接受PPCI，17例患者在PSM前接受FPCI。接受FPCI的患者比接受PPCI的患者年轻（50.8±14.0岁对64.1±14.2岁，p=0.001），FPCI患者中慢性肾脏病（CKD）的发生率低于接受PPCI的患者（0%对24.6%，p=0.024）。PSM前DTN明显短于DTB（25.8±4.2对61.1±10.7，p=0.000）。PSM后DTN明显短于DTB（26.9±4.2对64.9±23.6，p=0.000）；然而，两组院内缺血和出血不良临床结局的发生率相当。
在COVID-19大流行期间，溶栓治疗联合延迟PCI可缩短缺血时间，且与直接PCI患者相比，院内不良临床结局发生率相似。
