关键词: 急性ST段抬高型心肌梗死, 冠脉介入治疗, 严重心力衰竭, 恶性心律失常, 心源性死亡

Abstract: Objective To compare the effect of different timing of coronary intervention on the long-term prognosis of acute ST-segment elevation myocardial infarction patients with onset time over 12 hours. Methods A total of 173 acute ST-segment elevation myocardial infarction patients with onset time over 12 hours from October 2017 to December 2018 in the Department of Cardiology, Affiliated Hospital of Hebei University were admitted, and were divided according to the timing of percutaneous coronary intervention(PCI)into early PCI group(12-24 hours, 81 cases)and late PCI group(>24 hours, 92 cases). The follow-up period was 4 years. Primary endpoints were cardiogenic death, acute myocardial infarction, and secondary endpoints were definite or probable stent thrombosis, ischemia-driven target vessel revascularization, severe heart failure(NYHA class Ⅲ and Ⅳ cardiac function), and malignant arrhythmias. Results There was no significant difference between the two groups in the incidence of acute myocardial infarction, definite or probable stent thrombosis, target vessel revascularization driven by ischemia and malignant arrhythmia. However, the incidence of severe heart failure(NYHA class Ⅲ and Ⅳ cardiac function), and cardiac death in the early PCI group were higher than that in the late PCI group, and the differences were statistically significant(P<0.05). Conclusion For acute STEMI patients who missed the optimal time of PCI, PCI after 24 hours shows a lower incidence of heart failure and cardiac death and has a better clinical prognosis.

Key words: acute ST-segment elevation myocardial infarction, percutaneous coronary intervention, severe heart failure, malignant arrhythmia, cardiac death