在患有ST细分升高心肌梗塞的患者中,随着和没有心脏性休克的反延迟和结果
Andrew Kochan1, Terry Lee2, Nima Moghaddam3
1Division of Cardiology, Department of Medicine (A.K., J.A.C., G.C.W., C.B.F.), University of British Columbia, Vancouver, Canada.
Circulation. Cardiovascular interventions
|June 20, 2023
概括
对ST升高心肌梗塞 (STEMI) 与心脏性休克 (CS) 进行反治疗的延迟显著增加了死亡率. 减少第一次医疗接触到设备的时间对于改善这些高风险患者的治疗结果至关重要.
科学领域:
- 心脏病学 心脏病学
- 紧急医疗 紧急医疗
- 临床研究 临床研究
背景情况:
- 在ST升高心肌梗塞 (STEMI) 患有心脏性休克 (CS) 的患者中,死亡率仍然很高.
- 早期的再输液治疗对于改善STEMI患者的治疗结果至关重要.
- 在有或没有CS的STEMI中,再注射时间和不良事件之间的关联需要进一步调查.
研究的目的:
- 分析第一次医疗接触 (FMC) 到皮肤冠状动脉血管学 (装置) 时间和死亡率之间的关系.
- 为了评估FMC-to-device时间和主要不良心血管事件 (MACE) 之间的关联,在有或没有CS的STEMI患者中.
- 为了确定反延迟对STEMI患者复杂的结果的影响.
主要方法:
- 温哥华沿海卫生局STEMI注册表 (2010-2020年) 的回顾性分析.
- 包括接受初级皮肤穿冠状动脉血管造影的STEMI患者,根据CS的存在或不存在分层.
- 混合效应物流回归与受限制的立方线,以建模FMC到设备的时间和结果.
主要成果:
- 在2929名STEMI患者中,9.4%患有CS.
- 与没有CS (103.0分钟) 的患者相比,CS患者的FMC-to-device中位数时间 (113.5分钟) 较长.
- 对于每10分钟的FMC-to-device时间延迟 (60-90分钟),CS患者的死亡率增加4-7%,而非CS患者的死亡率<0.5%.
结论:
- 再输血延迟显著与接受初级PCI的SC患者的STEMI结果更差有关.
- 需要采取紧急策略,缩短CS出现的STEMI患者的FMC-to-device时间.
- 减少再输血时间对于减轻这种脆弱人群的死亡率和MACE至关重要.
相关概念视频
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
29
Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
29
01:30Acute Coronary Syndrome I: Introduction
33
Acute Coronary Syndrome (ACS) encompasses a spectrum of heart conditions caused by sudden obstruction of coronary arteries, typically resulting from the rupture of an atherosclerotic plaque and subsequent thrombus (blood clot) formation. This obstruction can lead to partial or complete blockage of blood flow, causing varying degrees of myocardial ischemia or infarction.ACS includes the following clinical entities:Unstable Angina (UA)Non-ST-Elevation Myocardial Infarction (NSTEMI)ST-Elevation...
33
01:28Acute Coronary Syndrome IV: Interprofessional Care
13
IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
13
01:21Cardiopulmonary Resuscitation I: Adult
22
Cardiopulmonary resuscitation, or CPR, is a life-saving emergency procedure performed when a person's heart has stopped beating or they are no longer breathing. The foundation of CPR is Basic Life Support (BLS), which focuses on the early recognition of cardiac arrest, the immediate start of high-quality chest compressions, and the timely use of an automated external defibrillator (AED).Assessing Responsiveness and Checking the Carotid PulseWhen approaching an unresponsive person, first ensure...
22
01:20Blood Studies for Cardiovascular System I: Cardiac Biomarkers
204
Cardiac biomarkers are enzymes, proteins, and hormones released into the blood when cardiac cells are injured. They are powerful tools for triaging.
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
The essential diagnostic tools for detecting myocardial necrosis and monitoring individuals suspected of having acute coronary syndrome (ACS) include:
Troponins
Troponins, particularly cardiac troponins I and T, are the most precise and sensitive markers of myocardial injury. They are detectable within 4-6 hours of myocardial injury and remain...
204