目的: 探究首诊至球囊扩张时间（door-to-balloon,D2B）延迟对急性前壁心肌梗死患者血运重建效果及心肌酶学指标的动态影响。方法: 回顾性分析2022年7月1日到2024年6月30日我院收治、确诊并接受冠脉介入治疗的急性前壁心肌梗死患者105例病例资料,根据首诊至球囊扩张时间窗（D2B）不同,按1∶1∶1比例匹配分为A（D2B≤60 min）、B（60 min<D2B≤120 min）、C（D2B>120 min）三组,各35例。比较三组治疗后临床疗效、血运重建成功率、临床症状缓解及住院时间、心肌酶学指标[肌酸激酶（creatine kinase,CK）、肌酸激酶同工酶（creatine kinase isoenzyme-MB,CK-MB）]在治疗后6、12、24、72 h动态变化,心功能指标及不良事件发生率。结果: A组总有效率为94.29%,明显高于B组（77.14%）和C组（71.43%）。A组血运重建成功率为97.14%,明显优于B组（82.86%）和C组（77.14%）。临床症状缓解时间与住院时间,A组明显短于B、C组。三组治疗前CK、CK-MB水平差异无统计学意义;治疗后6、12、24、72 h,A组CK与CKMB水平均低于B、C组。治疗后,三组左室射血分数均有所改善,相比B、C组,A组的左室射血分数升高幅度最大,左室舒张末期容积和左室收缩末期容积下降最明显。A组不良事件发生率为2.86%,B组为8.57%,C组为22.86%,组间差异无统计学意义。结论: 急性前壁心肌梗死患者D2B时间越短,其经皮冠状动脉介入治疗后临床疗效越佳,可明显提高冠脉血运重建成功率和恢复心功能。
Abstract
Objective To investigate the impact of door-to-balloon (D2B) time delay on revascularization efficacy and the dynamic changes of myocardial enzyme levels in patients with acute anterior myocardial infarction (AMI). Methods A retrospective analysis was conducted on 105 patients diagnosed with acute anterior wall myocardial infarction (AMI) who were admitted to our hospital and underwent percutaneous coronary intervention (PCI) between July 1, 2022, and June 30, 2024. Patients were evenly assigned to three groups (n=35 per group) based on the time from first medical contact to balloon inflation (door-to-balloon time, D2B): Group A (D2B ≤60 minutes), Group B (60 minutes <D2B≤120 minutes), and Group C (D2B>120 minutes). Post-treatment comparisons among the groups included clinical efficacy, success rate of coronary revascularization, time to symptom relief, and length of hospital stay. Serial measurements of myocardial enzyme levels—creatine kinase (CK) and creatine kinase isoenzyme-MB (CK-MB) —were performed at 6, 12, 24, and 72 hours after PCI to evaluate dynamic changes in myocardial injury. In addition, cardiac function was assessed using left ventricular ejection fraction (LVEF), left ventricular end-systolic volume (LVESV), and left ventricular end-diastolic volume (LVEDV). The incidence of adverse cardiac events was also recorded and compared across the three groups. Results Group A demonstrated a significantly higher overall efficacy rate (94.29%) compared to Group B (77.14%) and Group C (71.43%). The success rate of revascularization in Group A (97.14%) was also significantly greater than in Groups B (82.86%) and C (77.14%). Time to symptom relief and hospital stay were notably shorter in Group A. Baseline CK and CK-MB levels showed no significant differences among the groups; however, at 6, 12, 24, and 72 hours post-treatment, levels in Group A were significantly lower than in the other groups. All groups showed improvement in LVEF after treatment, with the greatest increase observed in Group A. Additionally, reductions in LVEDV and LVESV were most pronounced in Group A. The incidence of adverse events in Group A was 2.86%, compared with 8.57% in Group B and 22.86% in Group C. The differences between groups were not statistically significant. Conclusion Shorter D2B time is associated with better clinical outcomes in patients with acute anterior AMI undergoing PCI. Prompt intervention significantly enhances revascularization success.
关键词
急性前壁心肌梗死 /
D2B时间 /
经皮冠状动脉介入 /
心肌酶学指标 /
心功能
Key words
acute anterior myocardial infarction /
door-to-balloon time /
percutaneous coronary intervention /
myocardial enzyme markers /
cardiac function
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基金
阳江市医疗卫生科技计划项目“急性前壁心梗急诊冠脉介入治疗不同时间窗差异及效果中的应用研究”（SF2022059）
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