| Background:In China,the morbidity of STEMI increases year by year,and there is about 200,000 patients dying of AMI,with a in-hospital mortality up to 10.1%.Early reperfusion therapy(within 12h)is the main treatment to save STEMI patients.However,it is reported that in 2001-2011,the median time needed for patients to arrive hospital is beyond 12h after the event occurs,and there is only 30%patient could receive early reperfusion therapy in these 3 years.How to improve the prognosis of these STEMI patients have become the major challenge of clinical work.The most important factor of prognosis is the time interval from the event onset to the moment receving reperfusion therapy.Guidelines strongly recommend patients to receive eary reperfusion therapy within 12h from symptom onset.However,the evidents of "12h" mainly lie in the frinolyis era.Now the era of PCI has come,and the "12h" time window is not completely proper.It has been shown that surviving myocardial tissue still presents even 12h after myocardial ischemia.Comparing patients with patent infarct related artery with those with occlusive infarct related artery,it is indicated that PCI can decrease infarct size,improve left ventricle function and improve clinical outcome.However,although late reperfusion therapy can improve clinical outcome,when is the best time to perform reperfusion and whether all different time can lead to a better prognosis are unclear.In traditional oponion,mycardial scar tissue appears 1 week after STEMI and is risk of post-MI mechanical complications,such as perforation of ventrical aneurysm.The acute phase after MI has the characteristics of high thrombosis load,unstable electrophysiology,and thus performing PCI too early will result in distant thrombosis,reperfusion injury and even no reflow.Therefore,some researchers recommend to perform elective PCI 1 week after MI even later.But some studies indicates no benefits from late reperfusion therapy during 3-28d.So,when to do the late reperfusion therapy is extremely important.Studies about how different time of late reperfusion affect prognosis in real world with large sample size are lack.The existing studies confine in the comparison of effect beween late reperfusion therapy and consertive therapy.Comparsion between different time is lack and guidelines have no related suggestions.As interventional techniques develop and with the use of diferent types of stent,faciliated drugs improving prognosis,such as antiplatelet drugs and statins,the incidence of perioperative complications decreases year by year,and more and more doctors advance the time for late reperfusion therapy to shorten hospital stay,speed up the bed turnover,decrease hospital infection and lower the medical cost.Objective:The aim of this study is to investigate the effect of late reperfusion therapy in different time on poor prognosis in patients with acute ST elevation myocardial infarction,and thus decide the best time for late reperfusion therapy,providing evidence-based treatment in clinical practice.Methods:717 patients with STEMI and receiving selective percutaneous coronary i ntervention therapy were selected from January 1st,2012 to December 30th,2014.According to the time receiving PCI,these patients were divided into 3 groups:<3d(n=70)?3-6d(n=168)and ?7d(n=482).The demographic data,cl inical data,coronary angiography data and major adverse cardiovascular events(MACEs)were compared.Results:15(2.1%)patients died and 151 patients occurred with MACEs during th eir hospital stay.The mortality rates between 3 groups have no statistic differ ence(0 vs 3.0 vs 2.1%,P=0.332).Although incidence rate of MACEs increas ed in trend,it had no statistic difference(17.1 vs 19.4 vs 22.2%,P=0.524).There are total 635 patients completing median 3.5 years of following up,an d 283 of them had MACEs occurred.The incidence increased in these three group and the difference was statistic significant(25.8%vs 39.5%vs 48.6%,p=0.001).The Multivariate logistic regression analysis among patients showedage,hypertension,diabetes,and killip grade ?2 were independent risk factor f or MACEs.Besides,receiving reperfusion therapy>7d would increase the risk of MACEs(OR=2.681,95%CI=1.435-5.011,P=0.002)comparing with the<3 d group,and the 3-6d group had an increased trend(OR=1.911,95%CI=0.950-3.843,P=0.069).Subgroup analysis also showed that for patients with occlusiv e target vessel,incidence of MACE was lower(23.1%vs 52.6%vs 56.1%,p=0.007)in<3d group during follow-up.Long-term MACEs incidence was lowe r in early PCI group(27.8%vs 29.2%vs 44.0%,P=0.023).Conclusion:For patients with STEMI,early late PCI therapy can improve prognosis. |
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