急诊冠脉介入对发病12h内急性非ST段抬高型心肌梗死患者预后的影响

Effect of emergent coronary intervention on prognosis of patients with acute non-ST-segment elevation myocardial infarction within 12 hours of onset

关键词:  急性非ST段抬高型心肌梗死  急诊干预  经皮冠状动脉介入  预后

Key words:  acute non-ST-segment elevation myocardial infarction  emergency-intervention  percutaneous coronary intervention  prognosis

摘要:

目的探讨急诊冠脉介入治疗对比延迟介入治疗对发病12h的急性非ST段抬高型心肌梗死（non-ST-elevation myocardial infarction, NSTEMI）患者预后的影响。方法入选2018年1月至2019年8月在上海市浦东新区公利医院住院的发病12h内NSTEMI患者（n=222），随机分成急诊介入组（入院后2h内行介入治疗，n=111）和延迟介入组（入院后2～24h内行介入治疗,n=111），观察两组在发病后30、180d时主要心脏不良事件的发生率。随访终点包括全因死亡、心源性死亡、因心力衰竭加重住院、再发非致死性心肌梗死、靶血管再次血运重建等。结果急诊介入组和延迟介入组从入院到冠状动脉造影的中位数时间分别为1.3、12.2h（P＜0.001）。在30d随访时，两组终点事件发生率均较低，且组间差异无统计学意义（P＞0.05）；在180d随访时，延迟介入组较急诊介入组的终点事件的发生有增加趋势，但差异无统计学意义，但两组复合终点差异有统计学意义（4.36% vs 12.26%，危险比值：0.40，95%CI：0.17～0.97，P=0.041）。结论与延迟介入策略相比，发病12h内的NSTEMI患者行急诊介入策略可降低中期（180d）随访时心血管事件复合终点的风险。

Abstract:

ObjectiveTo assess the effect of emergent coronary intervention on the prognosis of acute non-ST-elevation myocardial infarction(NSTEMI) within 12h of onset. MethodsPatients with NSTEMI within 12h who were admitted to Gong-li Hospital from January 2018 to October 2019 were enrolled(n=222), and randomly divided into emergent intervention group(＜2h after admission, n=111) and delayed intervention group(2-24h after admission, n=111). The endpoints included all-cause death, cardiac death, readmission due to heart failure, recurrent nonfatal myocardial infarction, target vessel revascularization, at 30, 180d of follow-up. ResultsMedian time from admission to coronary angiography was 1.3h in emergent intervention group and 12.2h in delayed-intervention group(P＜0.001), respectively. At 30 d of follow-up there was no significant difference in endpoints between the two groups(P＞0.05). At 180 d of follow-up the incidence of endpoints in delayed-intervention group tended to be higher than that in emergency intervention group, but there was no significant difference(P＞0.05); however, there was a statistical difference in composite endpoints(4.36% vs 12.26%, hazard ratio：0.40, 95%CI：0.17~0.97;log rank P=0.041). ConclusionCompared with delayed intervention strategy, emergent intervention strategy for NSTEMI patients within 12h can reduce the risk of composite end-points of cardiovascular events at midterm(180 days) follow-up.