摘要
目的了解早期侵入与早期保守策略对中高危非ST段抬高急性冠状动脉综合征(ACS)患者住院主要不良心脏事件(MACE)发生情况的影响.方法根据入院后冠状动脉造影(CAG)与否和时间(≤48 h与＞48 h)对910例中高危非ST段抬高ACS患者分为早期侵入策略组(n=237)和早期保守策略(n=673)两组,分析早期策略与血管重建方式对住院MACE(包括死亡、新发心肌梗死和靶血管再次血管重建)的关系.结果早期侵入与早期保守组的住院病死率和靶血管血管重建率相当,早期侵入组的住院时间较短,住院MACE(6.3%比2.5%,OR 0.384,95% CI 0.188～0.781,P＝0.006)与新发心肌梗死(4.6%比0.9%,OR 0.185,95% CI 0.068～0.505,P＝0.001)的发生率更高.早期侵入组MACE与新发心肌梗死的增加可能与其血管重建操作较多(86.9%比67.5%,P<0.001)有关.亚组分析显示,早期侵入组与早期保守组中接受经皮冠状动脉介入治疗(PCI)的患者新发心肌梗死、靶血管再次血管重建(TVR)和MACE发生率均相当,无1例死亡;而早期侵入组中接受冠状动脉旁路移植术(CABG)的患者新发心肌梗死的发生率高于早期保守组中接受CABG的患者(7.5%比1.8%,P＝0.027).结论中高危非ST段抬高ACS患者采取早期侵入策略不增加住院病死率,但有可能增加住院心肌梗死.早期PCI安全可行,不增加住院主要不良心脏事件.早期CABG与住院不良事件的关系还有待进一步探讨.
Objective To demonstrate the effect of early strategies and revascularization patterns on in-hospital major adverse cardiac events (MACE) in patients with non-ST-segment elevation acute coronary syndrome (ACS) at intermediate or high risk. Methods 910 Patients with non-ST-segment elevation ACS at intermediate or high risk were divided into either early invasive (n=237) or initially conservative (n=673) group according to whether or when coronary angiography (CAG) was performed after admission (≤48 h or >48 h) in order to demonstrate the impact of early strategies and revascualarization patterns on in-hospital MACE events (death, new-onset myocardial infarction or repeat revascularization).Results Compared with those of the initially conservative group, patients in the early invasive group had a shorter hospital stay and increased rate of MACE (6.3% vs 2.5%,OR 0.384,95% CI 0.188-0.781,P=0.006) or new-onset myocardial infarction (4.6% vs 0.9%,OR 0.185,95% CI 0.068-0.505,P=0.001), which was partly due to increased procedures of revescularization (86.9% vs 67.5%, P<0.001). No differences were found among in-hospital mortality or rate of repeat revascularization between the two groups. During subgroup analysis, patients receiving PCI in the early invasive or initially conservative group had comparable rates of new-onset myocardial infarction, repeat revascularization or MACE events,whereas patients receiving CABG in the early invasive group had a higher rate of new-onset myocardial infarctions than those in the initially conservative group (7.5% vs 1.8%,P=0.027). Conclusions An early invasive strategy in patients with non-ST-segment elevation ACS had comparable in-hospital mortality and higher rate of in-hospital myocardial infarction compared with an initially conservative strategy, an early invasive strategy with PCI seems safe and feasible without increased risk of adverse clinical events. The impact of early CABG on in-hospital adverse events warrants further investigation.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2005年第4期307-311,共5页
Chinese Journal of Cardiology
