急性ST段抬高性心肌梗死患者直接经皮冠状动脉介入治疗再灌注时间对ST段回落的影响

目的探讨直接经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗中症状发作-球囊扩张时间(symptom-onset-to-balloon,SOTB)对再灌注后心电图ST段的回落、住院期间左心室射血分数、6个月内总的主要心血管事件(包括心绞痛、再发心肌梗死、因心血管事件再入院、心力衰竭和死亡等)发生率的影响。方法回顾性分析2005年1月至2006年7月于北京大学深圳医院行直接PCI治疗的ST段抬高性心肌梗死(ST-elevation myocardial infarction,STEMI)患者225例的基线资料、心电图资料以及随访资料,比较不同时间SOTB(>3 h及≤3 h)术前、术后1 h ST段抬高总和恢复百分比(sumSTR)%、住院期间超声心动图所测的左心室射血分数、随访6个月的主要心血管事件发生率。结果SOTB≤3 h组PCI治疗后1 h ST段完全回落≥70%的患者比例明显高于SOTB>3 h组,差异有统计学意义(57.4%vs.43.2%,P=0.005);住院期间左心室射血分数高于SOTB>3 h组,差异有统计学意义(57.69%±7.64%vs.53.80%±9.03%,P=0.014);6个月主要心血管事件发生率低与SOTB>3 h组,差异有统计学意义(14.9%vs.35.4%,P=0.001)。结论 STEMI患者PCI治疗中SOTB短,ST段回落就迅速而完全,住院期间的左心室射血分数高,6个月主要心血管事件发生率低。

Effect of time to reperfusion on ST-segment resolution after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction

Objectives To evaluate the effect of symptom-onset-to-balloon-time （SOTB） on electrocardiographic ST- segment resolution, left ventricular ejection fraction （LVEF） and incidence of major adverse cardiovascular events （including angina pectoris, re-infarction, rehospitalization due to cardiovascular events, heart failure and death, etc.） in 6 months in patients with ST-segment elevation myocardial infarction （STEMI） treated by primary percutaneous coronary intervention （PCI）. Methods Totally 225 patients with STEMI treated by primary PCI in Peking University Shenzhen Hospital from January 2005 to July 2006 were enrolled in this retrospective study. SumSTR% before and ! h after PCI, in-hospital left ventricular ejection fraction（LVEF） and incidence of MACE in 6 months between SOTB〉3 h group and SOTB ≤ 3 h group were compared. Results ST segment in full resolution ≥ 70% 1 h after PCI was significantly higher （57.4% vs. 43.2%,P=0.005）, in-hospital LVEF was significantly higher （57.69%±7.64% vs. 53.80%±9.03%, P= 0.014） and incidence of MACE in 6 months was significantly lower （14.9% vs. 35.4%, P=0.001） in SOTB≤3 h group than in SOTB〉3 h group. Conclusions The shorter of SOTB in patients with STEMI treated by primary PCI is, the more rapid and complete ST-segment resolution achieves, the higher of in-hospital LVEF becomes and the lower of incidence of MACE is.