ST 段抬高型心肌梗死 24 小时内不同时段直接经皮冠状动脉介入治疗时间与梗死面积、微血管阻塞及预后的关系

Relationship between primary percutaneous coronary intervention time of day, infarct size, microvascular obstruction and prognosis in ST-segment elevation myocardial infarction.

机构信息

Clinical Trials Center, Cardiovascular Research Foundation.

NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA.

出版信息

Coron Artery Dis. 2021 Jun 1;32(4):267-274. doi: 10.1097/MCA.0000000000000990.

DOI:10.1097/MCA.0000000000000990

PMID:33908405

Abstract

BACKGROUND

Whether the time of day of primary percutaneous coronary intervention (pPCI) in patients with ST-segment elevation myocardial infarction (STEMI) is associated with infarct size, microvascular obstruction (MVO), and prognosis is uncertain. We compared infarct size assessed by cardiac MRI (CMR) and clinical outcomes in STEMI patients according to the pPCI time of day from a large, individual patient-data pooled database.

METHODS

We pooled patient-level data from five randomized pPCI trials in which infarct size was measured within 1 month by CMR. Patients were categorized according to the pPCI time of day.

RESULTS

Among 1519 patients with STEMI, 794 (52.2%) underwent pPCI between 8:00 h and 15:59 h, 431 (28.4%) between 16:00 h and 23:59 h, and 294 (19.4%) between 24:00 h and 7:59 h. Infarct size was assessed in 1331 patients at a median of 3.0 days (interquartile range 2.0-5.0) after pPCI. Compared with patients who underwent PCI between 8:00 h and 15:59 h, infarct size was not significantly different for patients undergoing PCI from 16:00 h to 23:59 h [adjusted difference -0.7%, 95% confidence interval (CI) -3.1 to 1.7%, P = 0.46] or 24:00 h to 7:59 h (adjusted difference 0.9%, 95% CI -1.2 to 3.1%, P = 0.29). The time of day of pPCI was also unrelated to MVO and the 1-year risks of death or heart failure hospitalization.

CONCLUSION

In this large-scale, individual patient data pooled analysis, no association was found between the time of day of pPCI and infarct size, MVO, or prognosis after STEMI.

摘要

背景

ST 段抬高型心肌梗死（STEMI）患者行直接经皮冠状动脉介入治疗（pPCI）的时间与梗死面积、微血管阻塞（MVO）和预后的关系尚不确定。我们从一个大型的个体患者数据汇总数据库中比较了根据 pPCI 时间进行分类的 STEMI 患者的梗死面积评估和临床结局。

方法

我们汇总了五个随机 pPCI 试验的患者水平数据，这些试验均在 1 个月内通过心脏 MRI（CMR）测量了梗死面积。根据 pPCI 的时间将患者分类。

结果

在 1519 例 STEMI 患者中，794 例（52.2%）在 8：00 h 至 15：59 h 之间行 pPCI，431 例（28.4%）在 16：00 h 至 23：59 h 之间行 pPCI，294 例（19.4%）在 24：00 h 至 7：59 h 之间行 pPCI。在 1331 例患者中，在 pPCI 后中位数为 3.0 天（四分位距 2.0-5.0）评估了梗死面积。与 8：00 h 至 15：59 h 之间行 PCI 的患者相比，16：00 h 至 23：59 h 之间行 PCI 的患者[校正差异-0.7%，95%置信区间（CI）-3.1 至 1.7%，P=0.46]或 24：00 h 至 7：59 h 之间行 PCI 的患者[校正差异 0.9%，95%CI-1.2 至 3.1%，P=0.29]的梗死面积无显著差异。pPCI 的时间与 MVO 及 STEMI 后 1 年死亡或心力衰竭住院风险也没有关系。