Interventional Therapy
Safety and efficacy of regional transport combined with PCI model in patients with STEMI after thrombolysis in northwest China
Bai Ming, Pan Chenliang, Zhao Jing, Zhao Cunrui, Zhang Bo, Mu Zhongyuan, Meng Xiaoxue, Zhou Xinghu, Zhu Youqi, Zhang Zheng
Published 2020-08-24
Cite as Chin J Cardiol, 2020, 48(8): 641-647. DOI: 10.3760/cma.j.cn112148-20200228-00138
Abstract
ObjectiveTo investigate the safety and efficacy of regional transport to percutaneous coronary intervention(PCI) hospitals from non-PCI hospitals after thrombolysis in patients with acute ST-segment elevation myocardial infarction(STEMI) in northwest China.
MethodsIn this retrospective study, 1 062 STEMI patients who were transferred from non-PCI hospitals within 24 hours from symptom onset, during January 2015 and January 2019 in the First Hospital of Lanzhou University, were included. According to the treatment strategy, they were divided into two groups, namely intravenous thrombolysis combined with PCI group(n=240), and primary PCI group(n=822). Observation endpoint were in-hospital adverse cardiovascular and cerebrovascular events and bleeding events, Including all-cause death, ischemic stroke, malignant arrhythmia, intracranial hemorrhage and hemorrhage with hemoglobin decrease≥50 g/L.
ResultsA total of 1 062 STEMI patients were included(age was (61±12) years old), with 905 males (85.2%). The proportion of grade 0 TIMI blood flow in the primary PCI group before operation was significantly higher than that in the thrombolysis combined with PCI group(63.0%(518/822) vs. 36.3%(87/240)， P<0.001). Compared with primary PCI group, the time from symptom onset to first medical contact(2.11(1.00, 4.00)hours vs.3.00(1.13, 7.07)hours,P<0.001) and reperfusion in thrombolysis combined with PCI group(3.07(1.83, 4.87)hours vs. 6.92(4.07, 11.15) hours,P<0.001) were significantly shorter. The proportion of all-cause death was significantly higher in the primary PCI group than that in the thrombolysis combined with PCI group (1.8%(15/822) vs. 0,P=0.03). There was no significant difference in hemorrhage, ischemic stroke and malignant arrhythmia between the two groups(all P>0.05).
ConclusionsFor STEMI patients initially hospitalized in non-PCI hospitals, regional transport combined with PCI is feasible and effective. It does not significantly increase the risk of bleeding and cardiovascular and cerebrovascular events, with shorter time from symptom onset to myocardial reperfusion.
Key words:
Myocardial infarction; Percutaneous coronary intervention; Thrombolysis; Safety; Effectiveness
Contributor Information
Bai Ming
Heart Center, First Hospital of Lanzhou University, Lanzhou 730000, China
Pan Chenliang
Heart Center, First Hospital of Lanzhou University, Lanzhou 730000, China
Zhao Jing
Heart Center, First Hospital of Lanzhou University, Lanzhou 730000, China
Zhao Cunrui
Heart Center, First Hospital of Lanzhou University, Lanzhou 730000, China
Zhang Bo
Heart Center, First Hospital of Lanzhou University, Lanzhou 730000, China
Mu Zhongyuan
Heart Center, First Hospital of Lanzhou University, Lanzhou 730000, China
Meng Xiaoxue
Heart Center, First Hospital of Lanzhou University, Lanzhou 730000, China
Zhou Xinghu
Heart Center, First Hospital of Lanzhou University, Lanzhou 730000, China
Zhu Youqi
Heart Center, First Hospital of Lanzhou University, Lanzhou 730000, China
Zhang Zheng
Heart Center, First Hospital of Lanzhou University, Lanzhou 730000, China
