摘要
目的:探讨早期有创干预对急性冠脉综合征(ACS)患者远期预后的影响并对危险因素进行分析。方法:选择2001-2002年收住海口医院的ACS患者,按治疗方法的不同将患者分为早期有创干预组(PCI)和保守治疗组。对患者的预后进行随访,随访的终点为主要不良心脏事件(major adverse cardiovascular events,MACE),包括心脏性死亡、非致命性心肌梗塞、反复发生的心绞痛等。随访时间至少在12个月以上,比较两组病人预后的差别。对随访病人的常见危险因素进行测量,将测量结果对MACE作多因素Logistic回归分析,筛查主要的危险因子。结果:总共入选153例病人,其中PCI组66例,保守治疗组87例。随访时间最短19个月,最长56个月,平均46个月,其中54.6%的患者随访时间在36个月以上。早期有创干预组心肌梗塞和总的MACE的发生率显著低于保守治疗组,分别是8.5%、21.6%和32.9%、48.3%,P<0.05;两组的病死率无显著差异,分别是7.3%和8.3%。多因素分析表明,年龄、血糖、总胆固醇、HsCRP与MACE的发生密切相关,它们是MACE发生的独立预测因子。结论:早期有创干预可显著减少46个月时非致命性心肌梗塞和总的心血管事件的发生率,但不能减少心脏性死亡的发生。年龄、血糖、总胆固醇、HsCRP是影响预后的危险因素,它们对46个月时的不良心血管事件有独立的预测价值。
Aim：To explore the influence of early invasive strategy on the long-term prognosis in patients with acute coronary syndroms （ACS） and analyse the risk factors. Methods： Patients with ACS hospitalized from 2001 to 2002 were selected and categoried into early invasive strategy（PCI）and early conservative strategy according to treatment. A follow-up study was carried out. The end events is major adverse cardiovascular events （ MACE, cardiac death, nonfatal myocardial infarction and recurrent ischemla ang/na ）. The follow-up time was at least 12 months. The difference in prognosis between the two groups was analyzed. Common risk factors were measured in the follow-up patients and the primary risk factors for MACE were evaluated by multivariate logistic regression analysis. Results： A total 153 patients （66 in PCI and 87 in early conservative strategy） were followed up. The average follow-up time was 46 months, then the shortest and the longest follow-up time was 19 months, 56 months respectively.54. 6% of patients were followed up for at least 36 months. The incidence of nonfatal myocardial infarction and total cardiovascular events were 8.5% , 21.6% and 32.9% , 48.3% respectively, P 〈 0. 05 ; the death rate was 7.3% , 8.3% respectively and no significant difference was found. Multivariate logis tic regression analysis demonstrated a compact association between age, increased hsCRP,blood glucose level, Tc level and MACE, and they were respectively independent predictive factors for the increase of MACE. Conclusion：Early invasive strategy can significantly reduce the incidence of nonfatal myocardial infarction and total cardiovascular events in patients with ACS. Age, increased hsCRP, blood glucose level and Tc level are risk factors for the long-term prognosis.
出处
《暨南大学学报（自然科学与医学版）》
CAS
CSCD
北大核心
2007年第4期389-392,共4页
Journal of Jinan University(Natural Science & Medicine Edition)
关键词
急性冠脉综合征
远期预后
有创干预
保守治疗
危险因素
不良心脏事件
acute coronary syndromes
longegy
risk factors
major adverse cardiovascularterm prognosis
invasive strategy
conservative strat-events
