研究冠状病毒病2019(COVID-19)疫情对急性ST段抬高型心肌梗死(STEMI)患者就医方式、是否延迟就医、病情严重程度及医疗机构处置此类患者的方式有无变化。

以2019年1月1日至2020年3月31日北京大学深圳医院急诊入院的STEMI患者91例为研究对象进行回顾性病例研究，其中男性74例，女性17例；年龄29～89岁，平均(60.6±13.1)岁。将患者按照深圳市确诊COVID-19患者的最早发病时间(2020年1月1日)为节点，分为无疫情组和疫情组，分析其年龄、性别、基础疾病史(高血压、糖尿病、冠心病、高脂血症)、吸烟史等基线资料，比较来院方式、发病到就诊时间(PTD)、再灌注方式、门球(D2B)时间、心肌梗死溶栓治疗(TIMI)血流分级、多支冠状动脉血管病变(MVD)占比、转归及住院天数等的差异。

无疫情组患者的年龄为(57.9±12.6)岁，小于疫情组[(63.3±13.0)岁](P<0.05)，而性别、基础疾病史、吸烟史差异均无统计学意义(P均>0.05)。两组患者PTD时间、D2B时间、来院方式、住院天数、转归差异均无统计学意义(P均>0.05)。无疫情组患者选择直接经皮冠状动脉介入治疗(PCI)的占比为95.8%，高于疫情组的62.8%，但选择溶栓的占比例却低于疫情组0%比11.6%(P<0.05)。两组中直接PCI治疗患者术前TIMI 0/1级比例、术后TIMI 3级比例以及MVD率的差异均无统计学意义(P>0.05)。

COVID-19疫情期间，STEMI患者的平均就诊年龄相对较大，就医方式仍以自行就医为主，未发现就医延迟和疾病危重程度升高的现象，医疗机构对STEMI的处置方式上选择溶栓治疗的比例升高，直接PCI治疗的比例下降。

To investigate whether COVID-19 epidemic affected patients with acute ST-segment elevation myocardial infarction (STEMI) of the approach to medical treatment, delay of medical treatment and severity of the disease, and whether there were changes in the treatment of such patients by medical institutions.

A retrospective case study was conducted on 91 STEMI patients admitted to the Peking University Shenzhen Hospital between January 1, 2019 and March 31, 2020. 74 males and 17 females were enrolled, aged 29~89 (60.6±13.1) years . Patients were divided into no epidemic group and epidemic group according to the earliest onset time (starting dated January 1, 2020) of the COVID-19 patient in Shenzhen. Baseline data such as age, sex, history of underlying diseases (hypertension, diabetes, coronary heart disease, hyperlipidemia), and smoking history were analyzed, and the differences in clinical data, such as admission method, time from pain to door (PTD), reperfusion method, door to balloon (D2B) time, blood flow grade of thrombolysis in myocardial infarction (TIMI), proportion of multivessel disease (MVD), outcome and length of stay were compared between the two groups.

The age of patients in no epidemic group were (57.9±12.6) years, which were younger than those in the epidemic group [(63.3±13.0) years] (P<0.05); however, there were no statistically significant differences in gender, history of underlying diseases or smoking history (P>0.05). There were no statistical significance (P>0.05) between the two groups of patients in PTD time, D2B time, the way to hospital, hospitalization days and outcomes. The ratio of the patients choosing direct PCI in no epidemic group were 95.8%, which was higher than that in epidemic group (62.8%), and the ratio of choosing thrombolytic therapy in no epidemic group were lower than that of the epidemic group [0% vs. 11.6%] (P<0.05). There were no statistically significant differences in preoperative TIMI 0/1 ratio, postoperative TIMI level 3 ratio and MVD rate between the two groups (P>0.05).

In the period of the COVID-19 epidemic, the average age of treatment for STEMI patients is relatively older, and the way to hospital is still mainly by themselves, with no delay in medical treatment but increased degree of disease severity. The proportion of medical institutions choosing thrombolysis for treatment of STEMI increases, while the proportion of direct PCI decreases.