摘要
目的探讨入院时间对急性ST段抬高型心肌梗死(STEMI)患者预后的影响。方法连续入选2013年11月至2018年12月于首都医科大学宣武医院心脏内科就诊的1 322例STEMI患者,分为工作时间入院组518例(39.2%)和非工作时间入院组804例(60.8%)。比较两组患者住院期间心原性死亡和远期主要不良心脑血管事件(MACCE,包括全因死亡、心力衰竭、心原性休克、恶性心律失常、血运重建和脑卒中)发生情况。进一步对接受急诊再灌注治疗的患者进行亚组分析,比较两组患者发病至入院(OTD)、入院至球囊扩张(DTB)、发病至球囊扩张(OTB)时间差异,以及住院期间心原性死亡和远期MACCE发生情况。结果 1 322例STEMI患者中,与非工作时间入院组比较,工作时间入院组患者的收缩压和三酰甘油水平较低,而血肌酐和糖尿病患者比例较高(均为P<0.05)。工作时间入院组和非工作时间入院组患者的住院期间心原性死亡率(5.4%比7.0%,χ~2=1.288,P=0.256)和中位随访时间2.6年的MACCE发生率(27.9%比25.6%,χ~2=0.718,P=0.397)均无显著性差异。两组接受急诊再灌注治疗的比例分别为39.6%和46.6%(χ~2=6.388,P=0.011),亚组分析显示工作时间入院组患者的DTB时间显著低于非工作时间入院组[75.0(57.3,103.0)min比89.0(67.0,115.0)min,Z=-3.784,P=0.000],但OTB时间差异无统计学意义;两组患者住院期间心原性死亡率(2.0%比2.9%,χ~2=0.507,P=0.476)和远期MACCE发生率(18.4%比22.2%,χ~2=1.078,P=0.299)均无显著性差异。结论本单中心研究显示,非工作时间入院的STEMI患者接受再灌注治疗存在更长的院内救治时间延迟,但入院时间不影响患者的住院期间和远期预后。
Objective To explore the impact of admission time on the prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI).Methods A total of 1322 patients with STEMI were enrolled in this retrospective study from November 2013 to December 2018.Patients were divided into two groups--working hours admission group 518 patients(39.2%)and non-working hours admission group 804 patients(60.8%).The incidence of cardiac deaths during hospitalization and long-term major adverse cardiac cerebrovascular events(MACCE),including all-cause death,heart failure,cardiac shock,malignant arrhythmia,revascularization and stroke were compared between two groups.Further subgroup analysis was performed on the patients receiving emergency reperfusion therapy.Onset to door(OTD),door to balloon(DTB),onset to balloon(OTB)time,in-hospital cardiac deaths and long-term MACCE were also compared.Results Compared with non-working hours admission group,the patients in working hours admission group had lower systolic blood pressure and triglyceride,while the proportion of abnormal creatinine and diabetic patients were higher(all P<0.05).There were no statistically significant differences in in-hospital cardiac death(5.4%vs.7.0%,χ2=1.288,P=0.256)and 2.6-year MACCE(27.9%vs.25.6%,χ2=0.718,P=0.397).The proportion of emergency reperfusion therapy were 39.6%and 46.6%respectively,with significant difference(χ2=6.388,P=0.011).DTB time in working hours admission group was significantly lower than that in non-working hours admission group[75.0(57.3,103.0)min vs.89.0(67.0,115.0)min,Z=-3.784,P=0.000],while OTB was not significantly different in two groups.In-hospital cardiac death(2.0%vs.2.9%,χ2=0.507,P=0.476)and long-term MACCE(18.4%vs.22.2%,χ2=1.078,P=0.299)did not show difference.Conclusions Longer DTB time may exist for reperfusion therapy in patients with acute STEMI who admitted during non-working hours,but admission time may not affect the patient s hospitalization and long-term outcomes.
作者
左雪冰
张迎花
肖克令
司瑾
石宁
白兆润
苗祖霈
孙丽杰
李静
Zuo Xuebing;Zhang Yinghua;Xiao Keling;Si Jin;Shi Ning;Bai Zhaorun;Miao Zupei;Sun Lijie;Li Jing(Department of Cardiology,Xuanwu Hospital,Capital Medical University,Beijing 100053,China)
出处
《中国心血管杂志》
2020年第4期317-322,共6页
Chinese Journal of Cardiovascular Medicine
基金
北京市自然科学基金资助项目(7192078)。
关键词
入院时间
ST段抬高型心肌梗死
医院死亡率
远期
预后
Admission time
ST-segment elevation myocardial infarction
Hospital mortality
Long-term
Prognosis
