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目的了解目前我国ST段抬高急性冠状动脉综合征(ACS)再灌注治疗实施状况及近期预后。方法入选来自5个地区不同级别(从中心城市的三级医院到县级医院)20个中心的ST段抬高ACS或怀疑为新出现的左束支传导阻滞的患者共518例,对其临床特点,再灌注治疗情况及预后进行评价,并进行3个月随访。其中男371例,女147例,平均年龄(65±11)岁。随访率为99．6％。结果患者自症状开始到就诊的中位数时间为4 h,20％的患者在症状出现12 h以上就诊。292例(56％,292／518)ST段抬高ACS患者接受了再灌注治疗,其中134例(46％,134／292)接受了急诊冠状动脉介入(PCI)治疗,158例(54％,158／292)为溶栓治疗,溶栓治疗中尿激酶的应用占67％。从就诊到开始PCI的中位数时间(door-to-cath)为110 min,从患者就诊到开始溶栓的中位数时间为65 min。多因素回归分析显示,高龄(≥75岁,P<0．01)、有心肌梗死病史(P<0．01)及心力衰竭病史(P< 0．05)是未接受再灌注治疗的预测因素。非再灌注治疗组出院(P<0．01)和3个月病死率(P< O．01)、出院(P<0．01)和3个月心力衰竭发生率(P<0．01),以及3个月死亡或再梗死和死亡或再梗死或卒中的联合事件发生率(均P<0．01)均明显高于再灌注治疗组,但不同的再灌注治疗方法对近期预后无明显影响。相似的结果也见于症状出现12 h以内就诊患者的亚组分析。结论再灌注治疗是改善ST段抬高ACS患者预后的关键措施。我国ST段抬高ACS再灌注治疗有待于进一步提高,不仅要提高再灌注治疗率,更应缩短就诊和再灌注治疗前的延误时间,并加强高危患者的再灌注治疗。
Objective To understand the current status and prognosis of ST-segment elevation acute coronary syndrome (ACS) reperfusion in our country. METHODS: A total of 518 patients with ST-segment elevation ACS at 20 centers at different levels (from tertiary hospitals in the central city to county-level hospitals) or those suspected of presenting with new left bundle branch block were enrolled in this study. Clinical features, reperfusion treatment and prognosis were evaluated and 3 months follow-up. There were 371 males and 147 females, with an average age of (65 ± 11) years. Follow-up rate was 99.6%. Results The median time from symptom onset to treatment was 4 hours, with 20% of patients presenting for more than 12 hours. A total of 292 (56%, 292/518) ST-segment elevation ACS patients received reperfusion therapy, of which 134 (46%, 134/292) received emergency PCI and 158 (54% 158/292) for thrombolytic therapy, thrombolysis in the application of urokinase accounted for 67%. The median door-to-cath length from visit to start PCI was 110 min, and the median time to thrombolysis from the patient’s presentation to start-up was 65 min. Multivariate regression analysis showed that the older (≥75 years, P <0.01), the history of myocardial infarction (P <0.01) and the history of heart failure (P <0.05) were predictors of non-reperfusion therapy . The hospital discharge (P <0.01) and 3 months mortality (P <0.01), discharge (P <0.01) and 3 months incidence of heart failure in non-reperfusion group (All P <0.01) were significantly higher than those in reperfusion group after 3 months of death or reinfarction and death or reinfarction or stroke, but different reperfusion methods had no obvious prognosis in the near future influences. Similar results are also seen in the subgroup analysis of patients within 12 hours of symptom onset. Conclusion Reperfusion therapy is the key measure to improve the prognosis of ST-segment elevation ACS. ST-segment elevation ACS reperfusion therapy in our country needs to be further improved, not only to improve the rate of reperfusion treatment, but also to shorten the treatment and reperfusion delay before treatment, and to strengthen the re-treatment of high-risk patients.