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COVID-19 对中国武汉行直接经皮冠状动脉介入治疗的 ST 段抬高型心肌梗死患者短期预后的影响。

The impact of COVID-19 on short-term prognosis of ST-segment elevation myocardial infarction patients receiving primary percutaneous coronary intervention in Wuhan China.

机构信息

Department of Cardiology, General Hospital of Central Theater Command, Wuhan, 430070 Hubei, P. R. China.

The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515 Guangdong, P. R. China.

出版信息

Rev Cardiovasc Med. 2021 Mar 30;22(1):247-256. doi: 10.31083/j.rcm.2021.01.243.

Abstract

ST-segment elevation myocardial infarction (STEMI) is a common cardiovascular emergency for which timely reperfusion therapies are needed to minimize myocardial necrosis. The aim of this study was to investigate the impact of the COVID-19 pandemic and reorganization of chest pain centers (CPC) on the practice of primary percutaneous coronary intervention (PPCI) and prognosis of STEMI patients. This single-center retrospective survey included all patients with STEMI admitted to our CPC from January 22, 2020 to April 30, 2020 (during COVID-19 pandemic in Wuhan), compared with those admitted during the analogous period in 2019, in respect of important time points of PPCI and clinical outcomes of STEMI patients. In the present article, we observed a descending trend in STEMI hospitalization and a longer time from symptom onset to first medical contact during the COVID-19 pandemic as compared to the control period (4.35 h versus 2.58 h). With a median delay of 17 minutes in the door to balloon time (D2B), the proportion of in-hospital cardiogenic shock was significantly higher in the COVID-19 era group (47.6% versus 19.5%), and major adverse cardiac events (MACE) tend to increase in the 6-month follow-up period (14.3% versus 2.4%). Although the reorganization of CPC may prolong the D2B time, immediate revascularization of the infarct-related artery could be offered to most patients within 90 minutes upon arrival. PPCI remained the preferred treatment for patients with STEMI during COVID-19 pandemic in the context of timely implementation and appropriate protective measures.

摘要

ST 段抬高型心肌梗死(STEMI)是一种常见的心血管急症,需要及时进行再灌注治疗,以最大限度地减少心肌坏死。本研究旨在探讨 COVID-19 大流行和胸痛中心(CPC)重组对 STEMI 患者经皮冠状动脉介入治疗(PPCI)实践和预后的影响。这项单中心回顾性调查纳入了 2020 年 1 月 22 日至 4 月 30 日(武汉 COVID-19 大流行期间)期间我院 CPC 收治的所有 STEMI 患者,并与 2019 年同期相匹配,比较了 PPCI 的重要时间点和 STEMI 患者的临床结局。本研究观察到 COVID-19 大流行期间 STEMI 住院人数呈下降趋势,从症状发作到首次医疗接触的时间较对照期延长(4.35 h 比 2.58 h)。D2B 时间中位数延迟 17 分钟,COVID-19 时代组院内心源性休克的比例明显更高(47.6%比 19.5%),6 个月随访期间主要不良心脏事件(MACE)有增加趋势(14.3%比 2.4%)。尽管 CPC 的重组可能会延长 D2B 时间,但大多数患者在到达后 90 分钟内可实现梗死相关动脉的即刻再血管化。在 COVID-19 大流行期间,PPCI 仍然是 STEMI 患者的首选治疗方法,只要及时实施并采取适当的保护措施。

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