【摘要】 目的分析COVID-19大流行对感染低风险的ST段抬高型心肌梗死(STEMI)直接经皮冠状动脉介入治疗(PPCI)的患者基于远程区域联合多学科的救治效率和院内预后的影响。方法该研究为单中心回顾观察性研究,连续入选2020年1月至2020年3月和2019年于首都医科大学附属北京潞河医院心脏重症单元对发病12 h内经PPCI治疗的164例STEMI患者,依据发病是否在COVID-19疫情大流行期,分为疫情组(61例)和非疫情组(103例)。搜集两组一般临床资料和冠状动脉(冠脉)介入相关数据,主要终点为两组患者救治效率指标、心肌梗死面积、院内急性心力衰竭和心源性休克的比较;次要终点为院内主要不良心脑血管事件(MACCE)包括心血管死亡、再发非致死性心肌梗死、靶血管再次血运重建和卒中事件。结果入选患者平均年龄(58.7±11.7)岁,包括132例男性(80.5%)。疫情组与非疫情组比较,首次医疗接触到器械(FMC2D)中位数时间(120 min vs.78 min,P<0.001)和门器械中位数时间(D2D)[91 min vs.61 min,(P<0.001)]延长,FMC2D(50.8 min vs.71.8 min,P=0.007)和D2D达标率(47.5% vs.81.6%,P<0.001)降低。肌酸激酶峰值(2393 μ/L vs.1645 μ/L,P=0.016)和肌酸激酶同工酶峰值(199 μ/L vs.135 μ/L,P=0.02)较高,急性心力衰竭发生(24.6% vs.5.8%,P<0.001)比例增加,住院时间天数延长(5.67±2.89 vs.4.44±2.02,P=0.001)。总缺血时间和院内MACCE事件差异均无统计学意义。结论 COVID-19的暴发降低了低风险感染的STEMI经PPCI治疗患者的院内救治效率,导致系统延误,增加了心肌梗死面积、院内心力衰竭的发生,延长了住院时间。更多还原

【Abstract】 Objective To analyze the influence of COVID-19 craze on rescue efficiency based on remote regional combination of multidiscipline and in-hospital prognosis in patients with low-risk ST-segment elevation myocardial infarction (STEMI) undergone PPCI.Methods This study was a single-center retrospective observation.STEMI patients (n=164) undergone PPCI within 12 h after disease attack were chosen from Beijing Luhe Hospital affiliated to Capital Medical University from Jan.2020 to Mar.2020 and in the same period in 2019.All patients were divided,according to whether their attacks during COVID-19 craze or not,into epidemic group (n=61) and non-epidemic group (n=103).The general clinical materials and data related to PCI were collected in 2 groups.The primary endpoint events were rescue efficiency indexes,area of myocardial infarction (MI),in-hospital acute heart failure (AHF) and cardiogenic shock (CGS),and secondary endpoint events were in-hospital major adverse cardiovascular and cerebrovascular events (MACCE),non-fatal MI,target vessel revascularization (TVR) and stroke.Results The average age of selected patients was (58.7±11.7),among them male patients were 132 (80.5%).Comparison with non-epidemic group,the median time of the first medical contact to device time (FMC2D),(120 min vs.78 min,P<0.001) and median time of door to device (D2D,91 min vs.61 min,P<0.001) were prolonged,compliance rates of FMC2D (50.8 min vs.71.8 min,P=0.007) and D2D[47.5% vs.81.6%,(P<0.001)]decreased,peak value of creatine kinase (2393 μ/L vs.1645 μ/L,P=0.016) and peak value of creatine kinase-MB isoenzyme (199 μ/L vs.135 μ/L,P=0.02) increased,proportion of acute heart failure (24.6% vs.5.8%,P<0.001) increased,and length of hospital stay (5.67±2.89 vs.4.44±2.02,P=0.001) was longer in epidemic group.The difference in the total ischemia time and in-hospital MACCE had no statistical significance between 2 groups.Conclusion The outbreak of COVID-19 epidemic reduces in-hospital rescue efficiency,results in system delays,enlarges myocardial infarction size,increases incidence of in-hospital heart failure and prolongs hospital stay in patients with low-risk STEMI undergone PPCI.更多还原