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目的:比较急诊室-导管室与急诊室-CCU(病房)-导管室这2种临床途径直接经皮冠状动脉介入治疗(PCI)对急性ST段抬高心肌梗死(STEMI)患者住院期和远期预后的影响。方法:分析12 h内接受直接PCI治疗的连续228例STEMI患者冠状动脉病变及干预情况,记录手术成功率、平均住院日、院内死亡率及随访期间终点事件发生率,并多因素回归分析心血管事件相关危险因素。结果:急诊室-导管室组(甲组)与急诊室-CCU-导管室组(乙组)临床特征、冠状动脉病变、PCI成功率及平均住院日相似。与乙组相比,甲组的就诊-球囊时间延迟缩短(P<0.01),住院期和随访期(32.3个月)死亡率及复合终点事件发生率显著减低(均P<0.05)。多因素回归分析表明,就诊-球囊时间(OR=1.01,P<0.05)和年龄(OR=1.06,P<0.05)与心血管事件发生率显著相关。结论:STEMI患者到达急诊室后,直接送导管室行PCI治疗可显著缩短就诊-球囊时间延迟,改善近期和远期临床预后。
OBJECTIVE: To compare the two clinical approaches of emergency room-catheter room and emergency room-CCU (ward) -cases for direct percutaneous coronary intervention (PCI) for patients with acute ST-segment elevation myocardial infarction (STEMI) The impact of the prognosis. Methods: The coronary artery lesions and interventions in 228 consecutive patients with STEMI undergoing direct PCI within 12 hours were analyzed. The success rate of surgery, average length of stay, hospital mortality and end point incidence during follow-up were recorded. Cardiovascular Event related risk factors. Results: The clinical features of emergency department-catheterization group (group A) and emergency department-CCU-catheterization group (group B) were similar to those of coronary artery disease, PCI success rate and average length of stay. Compared with group B, the treatment time of group A was shorter (P <0.01), and both the hospital stay and the follow-up period (32.3 months) and the composite end point were significantly lower (all P <0.05). Multivariate regression analysis showed that there was a significant correlation between treatment-balloon time (OR = 1.01, P <0.05) and age (OR = 1.06, P <0.05) with the incidence of cardiovascular events. CONCLUSIONS: STEMI patients who arrive at the emergency department and direct catheterization of the catheterization line can significantly shorten the treatment time-to-balloon delay and improve clinical outcomes in the immediate and long term.