老年急性ST段抬高型心肌梗死延迟就诊患者经皮冠状动脉介入治疗的最佳时机
Optimal timing of percutaneous coronary intervention in elderly patients with acute ST-segment elevation myocardial infarction presenting late.
作者信息
Jia Haiyan, Zhang Weifeng, Jia Shengqi, Zhang Jun, Xu Zhanwen, Li Yaqin
机构信息
Department of Cardiology, Affiliated Hospital of Hebei University, Baoding, China.
Department of Cardiology, Cangzhou Central Hospital, Tianjin Medical University, Tianjin, China.
出版信息
Kardiochir Torakochirurgia Pol. 2024 Sep;21(3):143-152. doi: 10.5114/kitp.2024.143685. Epub 2024 Sep 30.
INTRODUCTION
Primary percutaneous coronary intervention (PPCI) is an effective method for the clinical treatment of acute ST-segment elevation myocardial infarction (STEMI). For patients who miss the optimal time window, optimal management of these patients remains controversial.
AIM
To compare the effects of different timing of percutaneous coronary intervention on the long-term prognosis of elderly patients with acute ST-segment elevation myocardial infarction (STEMI) with time from symptom onset > 12 hours.
MATERIAL AND METHODS
Elderly acute STEMI patients with time from symptom onset > 12 hours in the period from July 2021 to July 2022 in the Department of Cardiology, Affiliated Hospital of Hebei University, were randomly divided into four groups: group 1 (immediate invasive strategy, percutaneous coronary interventions (PCI) < 24 hours after symptoms onset, = 80), group 2 (early invasive strategy, 24-< 72 hours after symptoms onset, = 80), group 3 (delayed invasive strategy after symptoms onset, 72-< 168 hours after symptoms onset, = 80), and group 4 (late PCI group after symptoms onset, ≥ 168 hours after symptoms onset, = 80). Primary study end points were 12-month cardiac mortality, nonfatal myocardial infarction (MI), target-vessel revascularization, and heart failure-related rehospitalization.
RESULTS
There were no significant differences between groups in cardiac mortality, nonfatal MI and target-vessel revascularization. During follow-up, heart failure-related rehospitalization was higher in group 1 than in the other groups (18.8% vs. 5.1% vs. 7.4% vs. 6.3%, = 0.010). Compared with group 1, group 2, group 3 and group 4 had lower heart failure-related rehospitalization (HR = 0.250, 95% CI: 0.083-0.753, = 0.014) (HR = 0.377, 95% CI: 0.146-0.971, = 0.043) (HR = 0.320, 95% CI: 0.116-0.879, = 0.027).
CONCLUSIONS
For acute STEMI patients who missed the optimal time of PCI, immediate PCI did not reduce adverse clinical outcomes.
引言
直接经皮冠状动脉介入治疗（PPCI）是急性ST段抬高型心肌梗死（STEMI）临床治疗的有效方法。对于错过最佳时间窗的患者，这些患者的最佳管理仍存在争议。
目的
比较不同时间的经皮冠状动脉介入治疗对症状发作时间>12小时的老年急性ST段抬高型心肌梗死（STEMI）患者长期预后的影响。
材料与方法
选取河北大学附属医院心内科2021年7月至2022年7月期间症状发作时间>12小时的老年急性STEMI患者，随机分为四组：第1组（即刻侵入性策略，症状发作后<24小时进行经皮冠状动脉介入治疗（PCI），n = 80），第2组（早期侵入性策略，症状发作后24 - <72小时，n = 80），第3组（症状发作后延迟侵入性策略，症状发作后72 - <168小时，n = 80），第4组（症状发作后晚期PCI组，症状发作后≥168小时，n = 80）。主要研究终点为12个月时的心源性死亡率、非致死性心肌梗死（MI）、靶血管血运重建和心力衰竭相关再住院率。
结果
各组在心源性死亡率、非致死性MI和靶血管血运重建方面无显著差异。随访期间，第1组心力衰竭相关再住院率高于其他组（18.8%对5.1%对7.4%对6.3%，P = 0.010）。与第1组相比，第2组、第3组和第4组心力衰竭相关再住院率较低（HR = 0.250，95%CI：0.083 - 0.753，P = 0.014）（HR = 0.377，95%CI：0.146 - 0.971，P = 0.043）（HR = 0.320，95%CI：0.116 - 0.879，P = 0.027）。
结论
对于错过PCI最佳时间的急性STEMI患者，即刻PCI并未降低不良临床结局。
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