학술논문
急性ST段抬高型心肌梗死患者溶栓治疗时间对住院期间主要不良心脏事件发生率的影响 / Impact of the time from symptoms onset to thrombolysis on in-hospital major adverse cardiovascular event rate in patients with acute ST-segment elevation myocardial infarction
Document Type
Academic Journal
Source
中华心血管病杂志 / Chinese Journal of Cardiology. 44(2):128-132
Subject
Language
Chinese
ISSN
0253-3758
Abstract
目的 探究我国急性ST段抬高型心肌梗死(STEMI)患者溶栓治疗时间延迟对住院期间主要不良心脏事件发生率的影响,为STEMI溶栓的规范化诊疗提供国人证据.方法 对我国15个省和自治区的101家二级医院2011年11月至2014年11月期间收入院的新发STEMI并进行了溶栓治疗的患者进行前瞻性登记研究,采用多因素logistic回归建模估计多因素调整后不同溶栓时间的住院主要不良心脏事件发生率(MACE)及各组成部分(再梗死、卒中和全因死亡)发生率.结果 在3 719例接受溶栓治疗的STEMI患者中,3 270例(88％)在发病12 h内接受溶栓.在控制了危险因素、既往病史、病情、药物治疗及干预措施等混杂因素影响后,随着溶栓时间的延迟,无论是否溶通,MACE发生率均显著递增(趋势检验P均＜0.05).多因素调整MACE发生率溶通组在0～5.9、6.0～11.9和≥12.0h分别为3.2％、3.9％和7.8％,未溶通组分别为11.6％、14.1％和25.2％(趋势检验P均＜0.05);多因素调整的再梗死发生率,溶通组在0～5.9、6.0～11.9和≥12.0 h分别为1.9％、1.5％和6.8％,未溶通组分别为3.9％、3.1％和13.6％,溶通组和未溶通组再梗死率均在溶栓时间延迟12.0 h以上时明显增高(P均＜0.05);在相同时间组,溶通组MACE发生率和再梗死率均明显低于未溶通组.结论 对STEMI患者的溶栓治疗应尽可能争取在发病6h内进行;发病超过12 h溶栓,住院期间再梗死率和MACE均显著增加.
Objective To explore the impact of thrombolytic therapy time delay on in-hospital major adverse cardiac event rate in patients with acute ST-segment elevation myocardial infarction (STEMI).Methods This survey was performed in 101 level 2 hospitals from 15 provinces or autonomous region in China.Patients admitted to these hospitals with acute STEMI during November 2011 to November 2014 and received thrombolytic therapy were eligible for this study.Multivariate logistic regression modeling was used to estimate the rate of in-hospital major adverse cardiac events (re-infarction,stroke and all-cause mortality)in patients with different thrombolytic time delay.Results A total of 3 719 STEMI patients received thrombolytic therapy,88％ (3 270 cases) of then were treated within 12 hours.After controlling for the impact of confounding factors,such as a variety of risk factors,past disease histories,the severity of STEMI,medication,interventions,etc,MACE rates significantly increased along with the thrombolysis time delay,no matter thrombolysis succeeded or not (trend test P ＜0.05).In group of successful thrombolysis,multivariate adjusted rate of MACE for 0-5.9 hours,6.0-11.9 hours and ≥ 12.0 hours were 3.2％,3.9％ and 7.8％;in group of unsuccessful thrombolysis,it was 11.6％,14.1％ and 25.2％ respectively (trend test P ＜ 0.05).The multivariate adjusted rates of re-infarction in group of successful thrombolysis as well as in group of unsuccessful thrombolysis significantly increased in proportion to thrombolysis time delay ≥ 12.0 h (trend test P ＜ 0.05).In group of successful thrombolysis,multivariate adjusted rate of re-infarction for 0-5.9 hours,6.0-1 1.9 hours and ≥ 12.0 hours were 1.9％,1.5％ and 6.8％;in group of unsuccessful thrombolysis,it was 3.9％,3.1％ and 13.6％,respectively.Within the same time delay group,MACE and re-infarction rates were significantly lower in successful thrombolysis group than in unsuccessful thrombolysis group (all P ＜ 0.05).Conclusion Thrombolytic therapy should be conducted within 6 hours after the attack.Both re-infarction or MACE rates are significantly increased in patients with more than 12 hours thrombolysis time delay.
Objective To explore the impact of thrombolytic therapy time delay on in-hospital major adverse cardiac event rate in patients with acute ST-segment elevation myocardial infarction (STEMI).Methods This survey was performed in 101 level 2 hospitals from 15 provinces or autonomous region in China.Patients admitted to these hospitals with acute STEMI during November 2011 to November 2014 and received thrombolytic therapy were eligible for this study.Multivariate logistic regression modeling was used to estimate the rate of in-hospital major adverse cardiac events (re-infarction,stroke and all-cause mortality)in patients with different thrombolytic time delay.Results A total of 3 719 STEMI patients received thrombolytic therapy,88％ (3 270 cases) of then were treated within 12 hours.After controlling for the impact of confounding factors,such as a variety of risk factors,past disease histories,the severity of STEMI,medication,interventions,etc,MACE rates significantly increased along with the thrombolysis time delay,no matter thrombolysis succeeded or not (trend test P ＜0.05).In group of successful thrombolysis,multivariate adjusted rate of MACE for 0-5.9 hours,6.0-11.9 hours and ≥ 12.0 hours were 3.2％,3.9％ and 7.8％;in group of unsuccessful thrombolysis,it was 11.6％,14.1％ and 25.2％ respectively (trend test P ＜ 0.05).The multivariate adjusted rates of re-infarction in group of successful thrombolysis as well as in group of unsuccessful thrombolysis significantly increased in proportion to thrombolysis time delay ≥ 12.0 h (trend test P ＜ 0.05).In group of successful thrombolysis,multivariate adjusted rate of re-infarction for 0-5.9 hours,6.0-1 1.9 hours and ≥ 12.0 hours were 1.9％,1.5％ and 6.8％;in group of unsuccessful thrombolysis,it was 3.9％,3.1％ and 13.6％,respectively.Within the same time delay group,MACE and re-infarction rates were significantly lower in successful thrombolysis group than in unsuccessful thrombolysis group (all P ＜ 0.05).Conclusion Thrombolytic therapy should be conducted within 6 hours after the attack.Both re-infarction or MACE rates are significantly increased in patients with more than 12 hours thrombolysis time delay.