再灌注治疗策略对ST段抬高急性心肌梗死患者预后的影响

摘要

Objective To evaluate the outcome of ST-segment elevation myocardial infarction (STEMI) patients received different reperfusion therapies. Methods The 238 consecutive STEMI patients were enrolled from February 2012 to December 2012. According to the current guideline of PCI and the choice of patients, the patients were divided into the groups of percutaneous coronary intervention (PCI), ifbrinolysis, and conservative medication. The major adverse cardiac events (MACE) was analyzed in a follow up of 6 months. Results (1) The enrolled patients included the 210 patients received PCI (88.2%), 14 patients received fibrinolysis (5.9%) and 14 patients received conservative medication (5.9%).The Median time of D2B was 110minutes.(2) The rate of late stent thrombosis was signiifcant higher in BMS than DES (n=2, 2.8%vs 0, P < 0.05) . (3) The PCI group had a signiifcantly higher incidence of stroke than the ifbrinolysis group and the conservative medication group (1.0%vs 0, P < 0.05;1.0%vs 0, P<0.05). (4) The PCI group had a signiifcantly higher incidence of bleeding compared to the thrombolysis group and the medication group (1.0% vs 0, P < 0.05; 1.0% vs 0%, P < 0.05). Conclusions The majority of STEMI patients received PCI;The D2B time, which was required<90 minutes in guideline of PCI, was found delayed in our study;Compared to ifbrinolysis and conservative medication, PCI showed better clinical outcomes of STEMI patients.%目的：观察ST段抬高急性心肌梗死（STEMI）患者再灌注治疗策略对STEMI患者预后的影响。方法选取2012年2月至2012年12月到河南科技大学第一附属医院就诊的STEMI患者238例，根据目前PCI诊疗指南和患者的意愿，分为PCI组、单纯溶栓治疗组或药物治疗组，了解本地区STEMI的诊疗现状，比较不同再灌注策略对STEMI患者预后的影响。结果（1）所有入选患者，随访6个月PCI组死亡9例（4.3%），单纯溶栓组死亡2例（14.3%），药物治疗组死亡2例（14.3%）；在行溶栓治疗的35例患者中，溶栓+PCI组21例中死亡1例（4.8%），与单纯溶栓组14例中死亡2例（14.3%）比较，两组间差异有统计学意义（P＜0.05）；D2B时间中位数110 min。（2） BMS组支架内晚期血栓形成的发生高于DES组，差异有统计学意义（2.8%比0，P＜0.05），但两组主要不良事件发生率差异无统计学意义（7.5%比6.9%，P＞0.05）。（3）PCI组脑卒中发生率显著高于单纯溶栓组和药物治疗组（1.0%比0，P＜0.05；1.0%比0，P＜0.05）；（4）PCI组出血发生率显著高于单纯溶栓组和药物治疗组（1.0%比0，P＜0.05；1.0%比0，P＜0.05）。结论多数STEMI患者选择PCI；但D2B时间较长，D2B＜90 min比例较低；与单纯溶栓和药物保守治疗相比， PCI更能改善STEMI患者的预后。