[Impact of symptom onset to first medical contact time on the prognosis of patients with acute ST-segment elevation myocardial infarction]

Zhonghua Xin Xue Guan Bing Za Zhi. 2017 May 24;45(5):393-398. doi: 10.3760/cma.j.issn.0253-3758.2017.05.006.
[Article in Chinese]

Abstract
in English, Chinese

Objective: To investigate the impact of symptom onset to first medical contact (SO-to-FMC)time on the prognosis of patients with acute ST-segment elevation myocardial infarction(STEMI). Methods: The clinical data of 341 consecutive STEMI patients, who were hospitalized to our hospital and received primary percutaneous coronary intervention(PCI) from August 2011 to April 2016, were retrospectively analyzed. The patients were divided into ≤90 min group (201 cases) and >90 min group (140 cases) according to the SO-to-FMC time. The treatment time, mortality and incidence of major adverse cardiac and cerebro-vascular events(MACCE) were analyzed. The risk factor of 1-year mortality after PCI and 1-year incidence of MACCE during the post-discharge follow-up period were analyzed by binary logistic regression analysis. The predictor of 4.5-year mortality after PCI was analyzed by multivariate Cox regression analysis. Methods The door to balloon time (104(88, 125) min vs. 111(92, 144)min, P=0.023), first medical contact to balloon time(146(119, 197) min vs. 177(125, 237)min, P=0.005), and symptom onset-to-balloon time(200(170, 257) min vs. 338(270, 474)min, P<0.001)were all significantly shorter in the ≤90 min group than in>90 min group. The 30-day mortality (2.99% (6/201) vs. 7.86%(11/140), P=0.042), 1-year mortality (2.89 (5/173) vs. 9.57(11/115), P=0.015), 1-year incidence of MACCE during the post-discharge follow-up period(1.16%(2/173) vs. 6.96%(8/115), P=0.021), and 4.5-year cumulative mortality(3.00% vs. 11.20%, P=0.007) after PCI were significantly lower in the ≤90 min group than in the >90 min group. Moreover, the 4.5-year incidence with free of MACCE (97.20% vs. 88.80%, P=0.025) during the post-discharge follow-up period was significantly higher in the ≤90 min group than in the >90 min group. In-hospital mortality was similar between the two groups (2.49%(5/201) vs. 6.43%(9/140), P=0.071). Results: The door to balloon time (104(88, 125) min vs. 111(92, 144)min, P=0.023) , first medical contact to balloon time(146(119, 197) min vs. 177(125, 237)min, P=0.005), and symptom onset-to-balloon time(200(170, 257) min vs. 338(270, 474)min, P<0.001) were all significantly shorter in the ≤90 min group than in >90 min group. The 30-day mortality(2.99% (6/201) vs. 7.86%(11/140), P=0.042), 1-year mortality (2.89(5/173) vs. 9.57(11/115), P=0.015), 1-year incidence of MACCE during the post-discharge follow-up period (1.16%(2/173) vs. 6.96%(8/115), P=0.021), and 4.5-year cumulative mortality (3.00% vs. 11.20%, P=0.007) after PCI were significantly lower in the ≤90 min group than in the >90 min group. Moreover, the 4.5-year incidence with free of MACCE (97.20% vs. 88.80%, P=0.025) during the post-discharge follow-up period was significantly higher in the ≤90 min group than in the >90 min group. In-hospital mortality was similar between the two groups (2.49%(5/201) vs. 6.43%(9/140), P=0.071). Results of binary logistic regression analysis showed that the SO-to-FMC time >90 min was the risk factor of 1-year mortality(OR=2.90, 95%CI 1.22-6.92, P=0.016) and 1-year incidence of MACCE (OR=5.19, 95%CI 1.21-22.20, P=0.026) during the post-discharge follow-up period. Multivariate Cox regression analysis demonstrated that the SO-to-FMC time >90 min was the risk factor of 4.5-year mortality after PCI in patients with STEMI (HR=2.88, 95%CI 1.10-7.53, P=0.031). Conclusion: Shorting the SO-to-FMC time can significantly reduce the treatment time of STEMI patients, short and long-term mortalities and the incidence of MACCE, and improve the prognosis of patients with STEMI.

目的： 探讨发病至首次医疗接触(SO-to-FMC)时间对急性ST段抬高型心肌梗死(STEMI)患者预后的影响。 方法： 回顾性分析2011年8月至2016年4月连续在解放军第三六医院接受直接经皮冠状动脉介入治疗的341例STEMI患者的临床资料。根据SO-to-FMC时间，将患者分为≤90 min组(201例)和>90 min组(140例)。分析两组的救治时间、病死率和主要不良心脑血管事件(MACCE)发生率。采用多因素logistic回归模型分析术后1年病死率及出院后1年MACCE发生率的危险因素，并采用Cox比例风险回归模型分析术后4.5年累计病死率的危险因素。 结果： ≤90 min组患者的入门至首次球囊扩张时间[104(88，125) min比111(92，144)min, P＝0.023]、首次医疗接触至球囊扩张时间[146(119，197) min比177(125，237)min, P＝0.005]、发病至首次球囊扩张时间[200(170，257) min比338(270，474)min, P<0.001]均短于>90 min组，术后30 d病死率[2.99% (6/201)比7.86%(11/140), P＝0.042]、1年病死率[2.89% (5/173)比9.57%(11/115), P＝0.015]、出院后随访1年的MACCE发生率[1.16%(2/173)比6.96%(8/115), P＝0.021]和术后4.5年的累计病死率(3.00%比11.20%, P＝0.007)均低于>90 min组，出院后随访4.5年的累计无MACCE生存率高于>90 min组(97.20%比88.80%, P＝0.025)。两组之间的院内病死率差异无统计学意义[2.49%(5/201)比6.43%(9/140), P＝0.071]。多因素logistic回归模型分析显示，SO-to-FMC时间>90 min是STEMI患者术后1年病死率(OR＝2.90, 95%CI 1.22～6.92, P＝0.016)和出院后1年MACCE发生率(OR＝5.19, 95%CI 1.21～22.20, P＝0.026)的独立危险因素。多因素Cox比例风险回归模型分析显示，SO-to-FMC时间>90 min是患者术后4.5年累计病死率的独立危险因素(HR＝2.88, 95%CI 1.10～7.53, P＝0.031)。 结论： 缩短SO-to-FMC时间可以显著减少STEMI患者救治时间，降低其近远期病死率及MACCE发生率，改善STEMI患者的预后。.

Keywords: Myocardial infarction; Prognosis; Time factors.

MeSH terms

  • Acute Disease
  • Hospital Mortality
  • Hospitals
  • Humans
  • Myocardial Infarction
  • Percutaneous Coronary Intervention*
  • Prognosis
  • Retrospective Studies
  • ST Elevation Myocardial Infarction* / mortality
  • ST Elevation Myocardial Infarction* / therapy
  • Time Factors