皮肤冠状动脉干预的最佳时间在老年患者急性ST段升高心肌梗塞呈现晚期
Haiyan Jia1,2, Weifeng Zhang1,2, Shengqi Jia3
1Department of Cardiology, Affiliated Hospital of Hebei University, Baoding, China.
概括
对于患有急性ST段升高心肌梗塞 (STEMI) 的老年患者,他们错过了最佳治疗窗口,即时穿皮冠状动脉干预 (PCI) 并没有改善长期结果. 与立即PCI相比,延迟的PCI策略显示,与心力衰竭相关的住院治疗减少了.
科学领域:
- 心脏病学 心脏病学
- 干预心脏病学 干预心脏病学
- 老年心脏病学 老年心脏病学
背景情况:
- 初级穿皮冠状动脉干预 (PPCI) 是急性ST段升高心肌梗塞 (STEMI) 的标准.
- 在理想时间窗口之外出现的STEMI患者的最佳管理仍在争论中.
- 老年患者对再输血策略的反应可能不同.
研究的目的:
- 为了比较老年STEMI患者的长期预后,在症状出现 (>12小时) 后的不同时间间隔内接受皮肤冠状动脉干预 (PCI) 治疗.
- 评估即时与延迟PCI对主要心脏不良事件和心力衰竭住院治疗的影响.
主要方法:
- 在320名老年STEMI患者的随机研究中,症状出现后超过12小时.
- 根据PCI时间,患者被分为四组:即时 (<24小时),早期 (24-72小时),延迟 (72-168小时) 和晚期 (≥168小时).
- 主要终点包括12个月心脏病死亡率,非致命性心脏病发作,目标血管再血管化和心力衰竭再住院.
主要成果:
- 两组之间没有观察到心脏死亡率,非致命的心肌梗塞 (MI) 或目标血管再血管化的显著差异.
- 与心力衰竭相关的再住院在即时PCI组 (18.8%) 与早期 (5.1%),延迟 (7.4%) 和晚期 (6.3%) PCI组相比显著更高.
- 与立即PCI相比,延迟的PCI策略 (早期,延迟,晚期) 与与心力衰竭有关的再住院病例显著减少.
结论:
- 在老年STEMI患者出现>12小时症状发作后的立即PCI并不能减少不良临床结果.
- 在这种患者群体中,延迟皮肤冠状动脉干预策略可能是可取的,以减少与心力衰竭相关的住院治疗.
- 进一步的研究是有必要的,以优化对迟出现的STEMI患者的再输血策略.
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