延迟经皮冠状动脉介入治疗的基线风险、时间窗和适应症及其在st段抬高型心肌梗死治疗中的意义

G. A. Gazaryan, G. A. Nefedova, G. G. Gazaryan, M. U. Keshtova, L. G. Tyurina, I. V. Zakharov, S. Yu. Kambarov, K. A. Popugaev
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引用次数: 0

摘要

本研究的目的是评估延迟经皮冠状动脉介入治疗(pci)在治疗st段抬高型心肌梗死(STEMI)中的意义,衡量初始死亡风险(MR),同时确定其使用适应症和住院晚期使用机械再灌注的时间窗口。2008年至2017年期间,共有2226例STEMI患者入院。急诊冠状动脉造影对945例入院患者在最初12小时内和834例在STEMI发作12 - 72小时后进行;分别有784例和619例患者行PCI。所有患者MR均采用TIMI评分;通过TIMI 3冠状动脉血流并与心电图再灌注体征进行比较来评估血管造影的成功。基线MR评分平均为5或12.5%,对应于最初12小时内行PCI的患者评分为4.2或8%,12 - 72小时后行PCI的患者评分为5或12.5%,未行PCI的患者评分为6或16%;65岁以下、65 - 75岁和75岁以上患者的MR评分分别为3.7或7%、6或16%和7.5或25%。早期和延迟PCI患者的死亡率分别为5.2%和4.2%,未行PCI患者的死亡率为15.6%;根据患者年龄分布,65岁以下、65 - 75岁和75岁以上,早期PCI术后死亡率分别为3.8%、4.9%和10.8%;延迟PCI后分别为2.6%、5.8%和8.2%;未行PCI的分别为8.4%、19.4%和28%。10年来,初级pci的数量从39%增加到78%。早期PCI和延迟PCI的比例分别为56%和44%。在195例死亡(67例行PCI治疗,128例未行PCI治疗)中,90%的患者患有三支血管疾病;心肌梗死面积大于30%的占83%;84%的死亡原因是肺水肿。目前的数据表明,延迟PCI对初始MR高的患者具有很高的实际意义,其最重要的组成部分是年龄超过75岁和急性心力衰竭(AHF)的严重表现。与早期pci不同,延迟pci的使用频率较低,最初的MR不被考虑在内,并且对于75岁以上的人来说是不使用的。死亡率的降低与基线MR成正比,表明它们与PCI结果和无年龄限制使用PCI的可行性相关。在晚期住院患者中,通过与早期患者类比或选择性地在高MR患者中使用原发性pci,将有助于优化治疗策略并降低死亡率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Baseline risk, time window, and indications for delayed percutaneous coronary interventions, their significance in treatment of ST-segment elevation myocardial infarction
The aim of the study was to estimate the significance of delayed percutaneous coronary interventions (PCIs) in the treatment of ST-segment elevation myocardial infarction (STEMI), to weigh the initial mortality risk (MR) while determining the indications for their use and the time window for the use of mechanical reperfusion in late hospital admission. Total 2226 patients admitted to the Institute with STEMI for the period 2008–2017 were studied. Emergency coronary angiography was performed in 945 admitted patients in the initial 12 hours and in 834 patients after 12–72 hours of STEMI onset; PCI was performed in 784 and 619 patients, respectively. In all patients, MR was scored by TIMI; angiographic success was assessed as TIMI 3 coronary flow and compared to ECG signs of reperfusion. The baseline MR score averaged 5 or 12.5%, being corresponded to score 4.2 or 8% in patients with PCI performed in the initial 12 hours, score 5 or 12.5% in those with PCI performed after 12–72 hours, and score 6 or 16% in patients without PCI; or with respect to the patient age, MR scored 3.7 or 7%, 6 or 16%, and 7.5 or 25%, for those under the age of 65 years, those from 65–75 years, and those over 75 years old, respectively. Mortality in patients with an early and delayed PCI was 5.2% and 4.2%, respectively, and 15.6% in patients without PCI; after patient distribution by age under 65, 65–75, and over 75 years old, the respective mortality rates were 3.8%, 4.9%, and 10.8% after an early PCI; 2.6%, 5.8%, and 8.2% after a delayed PCI; and 8.4%, 19.4%, and 28% among those without PCI. For 10 years, the number of primary PCIs had increased from 39% to 78%. The ratio of early to delayed PCI made 56% to 44%. Of 195 deaths (67 patients with PCI and 128 without PCI), 90% of patients had a three-vessel disease; 83% of patients had the MI area over 30%; and the cause of death in 84% was pulmonary edema. The presented data suggest a high practical significance of delayed PCI in patients with initially high MR, its most weighty components being the age over 75 years and severe manifestations of acute heart failure (AHF). Unlike early PCIs, the delayed PCIs are used less frequently, the initial MR is not taken into account, and they are abstained from in respect to people over 75 years of age. The reduction in mortality, proportional to the baseline MR, suggests their correlation to PCI results and the feasibility of PCI use without age restrictions. The use of primary PCIs in late hospital admissions, by analogy with early ones or selectively in high MR, will help to optimize the treatment tactics and minimize mortality.
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