بررسي عوامل موثر بر تاخير در رسيدن بيماران جهت انجام Primary PCI در زمان طلايي و ارتباط آن با حوادث قلبي-عروقي متعاقب

Evaluation of delay in Primary PCI in golden time and its relationship with major adverse cardiac events

در بيماران انفاركتوس ميوكارد با بالارفتن قطعه (STEMI) ST، مداخله كرونري از طريق پوست (PCI) اوليه، درمان ريپرفيوژن ترجيحي مي باشد. انجام به موقع Primary PCI براي بهبود پيش آگهي باليني اين بيماران ضروري مي باشد. هدف اين مطالعه بررسي عوامل موثر بر تاخير در رسيدن به مرحله بالون در بيماران STEMI تحت درمان با Primary PCI و ارتباط آن با حوادث متعاقب بيماران مي باشد. روش بررسي اين مطالعه مشاهده اي آينده نگر بر روي 143 بيمار STEMI تحت Primary PCI از خرداد 1398تا خرداد 1399 بيمارستان امام خميني اهواز انجام شد. تمام اجزاي زماني از بروز علايم تا درمان PCI محاسبه شدند. ميزان بروز عوارض قلبي- عروقي ماژور (MACE) درطول 12 ماه و تغييرات LVEF سه ماه پس از Primary PCI نيز بررسي شدند. ﯾﺎﻓﺘﻪﻫﺎ: ﺑﯿﺸﺘﺮ ﺑﯿﻤﺎران )92/4%( داراي زﻣﺎن اﯾﺴﮑﻤﯿﮏ 120 دﻗﯿﻘﻪ و زﻣﺎن 90>door-to-device دﻗﯿﻘــﻪ )64/3%( ﺑﻮدﻧــﺪ. ﺑﻪﻃﻮر ﮐﻠﯽ 59 ﺑﯿﻤﺎر )41/3%( MACE را در ﻃﻮل ﯾﮏ ﺳﺎل ﻓﺎﻟﻮآپ ﺗﺠﺮﺑﻪ ﮐﺮدﻧﺪ، ﺷﺎﻣﻞ 13/3% ﺳــﻨﺪرم ﮐﺮوﻧــﺮي ﺣــﺎد، 22/4% ﻧﺎرﺳﺎﯾﯽ ﻗﻠﺒﯽ، 9/8% ﻣﺮگ ﻧﺎﮔﻬﺎﻧﯽ ﻗﻠﺒﯽ و 2/1% ﺳﮑﺘﻪ ﻣﻐﺰي. ﺳﻦ ﺑــﺎﻻ )0/020=P(، ﺗﻐﯿﯿــﺮات P=0/005) EF( و ﻧﻮع P=0/039) STEMI( ﭘﯿﺶﺑﯿﻨﯽﮐﻨﻨﺪه ﺑﺮوز MACE ﺑﻮدﻧــﺪ، درﺣﺎﻟﯽﮐــﻪ ﻣــﺪت زﻣــﺎن اﯾﺴــﮑﻤﯿﮏ )0/607=P( و زﻣــﺎن )0/347=door-to-device (P ارﺗﺒﺎﻃﯽ ﺑﺎ ﺑﺮوز MACE ﻧﺪاﺷﺘﻨﺪ. نتيجه گيري هيچيك از فاصله هاي زماني مورد بررسي با بروز MACE در فالوآپ يك ساله ارتباطي نداشت و بيشتر بيماران با تاخير زياد به بيمارستان مراجعه كردند. از اين رو تلاش براي كوتاه كردن زمان مراجعه به بيمارستان و زمان Door-to-device مي تواند به بهبود MACE در بيماران STEMI تحت Primary PCI كمك كند.

In patients with ST-segment elevation myocardial infarction (STEMI), Primary percutaneous coronary intervention (PCI) is the preferred reperfusion therapy. Timely primary PCI is essential in improving the clinical outcomes of these patients. The aim of this study was to evaluate the factors affecting balloon delay in STEMI treated patients by primary PCI and its relationship with major adverse cardiac events (MACE). Methods This prospective observational study was conducted on 143 cases of STEMI patients, who had the inclusion criteria and were treated by primary PCI, after obtaining written consent in Imam Khomeini hospital in Ahvaz, between May 2019 to May 2020. All-time components from symptom onset to PCI treatment include symptom-to-balloon time or ischemic time, symptom-to-door time and door-to-balloon time calculated. The incidence of major adverse cardiovascular events (MACE) including decompensated heart failure (DHF), acute coronary syndrome (ACS), sudden cardiac death (SCD) and cerebrovascular accident (CVA) was evaluated during 12 months follow up after primary PCI. left ventricular ejection fraction (LVEF) changes were evaluated 3 months after primary PCI. Results The median symptom-to-door time was 200.5 minutes (IQR: 90-438.75 min), the median ischemic time was 406 minutes (IQR: 231-671 min), and most patients had an ischemic time ≥120 minutes (92.4%) and door-to-device time ≥90 minutes (64.3%). The most common delay for treatment was in the symptom-to-door time (76.9%) and then the decision for primary PCI to transfer to the cat lab (17.5%). Overall, 59 (41.3%) of the patients experienced MACE during 1-year of follow-up, including ACS (13.3%), DHF (22.4%), cardiac death (9.8%) and CVA (2.1%). The patients age (OR: 0.96, P=0.020), LVEF changes (OR: 1.123, P=0.005) and STEMI type (OR: 0.705; P=0.039) predicted in-hospital MACE, while the symptom-to-balloon time (P=0.607) and door-to-balloon time (P=0.347) were not associated with MACE. Conclusion None of the time intervals were associated with the occurrence of MACE in one-year follow-up, and most STEMI patients were admitted to the hospital with a long delay. Therefore, efforts to shorten the time of hospitalization admission can help improve the MACE in STEMI patients under primary PCI in our medical centers.