[Long-term outcomes of patients with ST-elevation myocardial infarction undergoing early versus late delayed percutaneous coronary intervention using drug-eluting stents].

Objective: To compare the long-term outcomes in ST-elevation myocardial infarction (STEMI) patients who underwent early or late delayed percutaneous coronary intervention (PCI) using drug-eluting stents (DES). Methods: This study was a retrospective, observational and single-center study. Consecutive STEMI patients (n=977), who admitted to Fuwai Hospital in 2013 and underwent successful selective PCI using drug-eluting stents (DES) within 3 to 35 days after symptom onset were enrolled and divided into the early delayed PCI (3-14 d) group (n=495) and the late delayed PCI (15-35 d) group (n=482). General clinical data of the patients and related data of coronary angiography and interventional therapy were collected, and the endpoint events were followed up. The primary endpoint was 2-year major adverse cardiac and cerebrovascular events (MACCE) including cardiac death, recurrent myocardial infarction, definite or probable stent thrombosis and ischemic stroke. The secondary endpoint was 2-year ischemia-driven target vessel revascularization. The incidence of endpoint events of the two groups was compared, and it was compared again after the primary baseline characteristics such as age and gender were matched by the propensity scoring method at a 1∶1 ratio. Results: A total of 910 (93.1%) patients who underwent delayed PCI were transferred from other hospitals, and 292 (29.9%) patients received thrombolysis before PCI. The time interval before PCI was 14 (10, 20) days. The incidence of 2-year MACCE (3.0%(15/495) vs. 2.3%(11/482), P=0.468) and ischemia-driven target vessel revascularization (3.8%(19/495) vs. 5.0%(24/482), P=0.385) were similar between the two groups. The incidence of 2-year MACCE (3.3%(15/453 vs. 2.4%(11/453), P=0.426) and ischemia-driven target vessel revascularization (4.2% (19/453) vs. 4.9%(22/453), P=0.632) were also similar between the two groups after matching propensity score. Conclusion: The long-term clinical outcomes after early delayed PCI using DES is statistically equivalent to those of late delayed PCI using DES for STEMI patients who missed the time window for emergency PCI.目的： 比较ST段抬高型心肌梗死（STEMI）患者早期和晚期延迟经皮冠状动脉介入治疗（PCI）并置入药物洗脱支架（DES）的远期预后。 方法： 该研究为回顾性的单中心观察性研究。连续入选2013年于中国医学科学院阜外医院就诊并于发病后3~35 d行择期PCI并置入DES的STEMI患者977例。根据接受延迟PCI的时间将纳入患者分为早期PCI组（3~14 d，495例）和晚期PCI组（15~35 d，482例）。收集患者的一般临床资料以及冠状动脉造影和介入治疗等相关资料，随访终点事件的发生情况。主要终点为2年主要不良心脑血管事件（MACCE），包括心原性死亡、心肌梗死、明确或可能的支架内血栓以及缺血性卒中；次要终点为2年缺血驱动的靶血管血运重建。比较两组患者终点事件的发生率，并采用倾向性评分法按1∶1的比例匹配年龄、性别等主要基线特征后再次比较两组患者临床终点事件的发生情况。 结果： 接受延迟PCI的患者中有910例（93.1%）由外院转入，其中接受过溶栓治疗者292例（29.9%）。接受延迟PCI的时间为14（10, 20）d。早期PCI组和晚期PCI组患者2年MACCE[3.0%（15/495）比2.3%（11/482），P=0.468]和缺血驱动的靶血管血运重建[3.8%（19/495）比5.0%（24/482），P=0.385]发生率的差异均无统计学意义。匹配主要基线特征后，两组患者2年MACCE[3.3%（15/453）比2.4%（11/453），P=0.426]和缺血驱动的靶血管血运重建[4.2%（19/453）比4.9%（22/453），P=0.632]发生率的差异亦无统计学意义。 结论： 错过急诊PCI时间窗的STEMI患者行早期或晚期延迟PCI并置入DES远期预后相当。.