延迟造影对非ST段抬高急性冠脉综合征结果的影响

目的:探讨延迟造影(>72h)对非ST段抬高急性冠脉综合征(NSTE-ACS)结果的影响。方法:对2004～2008年在我院住院的NSTE-ACS高危患者(GRACE分级)的共396例进行研究,根据是否造影分为两组,分析比较两组及造影组不同时期患者住院期间及随访6个月缺血症状、心衰、及严重心血管不良事件(MACE)包括死亡,卒中,冠脉血运重建,再发心肌梗死等发生情况。结果:住院期间延迟造影与非延迟造影组相比有较高的缺血症状和心衰发生率(均P<0.05);与不造影相比有较低的发生率(均P<0.05),非延迟造影与非造影组相比差异有非常显著性(P<0.01)。随访6个月造影组各组临床事件(包括MACE)相比随时间延迟有升高趋势,但差异无显著性(P>0.05),造影组各组与非造影组相比,差异有显著性(P<0.05)。经用性别、年龄、体重指数、吸烟、心梗史、肾功能不全史、高血压、糖尿病、血脂异常、经皮穿刺冠状动脉治疗史、冠状动脉搭桥术史及ACS危险积分(GRACE积分)等因素调整后各组间上述关系仍存在。结论:NSTE-ACS高危患者不予造影处理结果不理想,而延迟造影短期同样存在较高的风险,随访半年后MACE率也存在同样关系,提示对NSTE-ACS高危患者宜采取积极的造影及干预措施。

Delay to angiography and outcomes following presentation with high-risk,non-ST-elevation acute coronary syndromes

Objectives：To test if delay-to-angiography （72 hours） in patients presenting with high-risk non-ST-elevation acute coronary syndromes （NSTE-ACS） was associated with adverse outcomes. Methods： 396 high-risk NSTE-ACS hospitalisation patients with complete initial data collection entered into GRACE between 2004 and 2008 were analysed. Data were analysed according to delay-to-angiography and subsequent in-hospital or postdischarge adverse outcomes. Outcomes recorded included recurrent ischaemia, new heart failure and composite major adverse cardiovascular event （MACE） comprising death, cerebrovascular accident, myocardial infarction and revascularisation. Result： Recurrent in-hospital ischaemia and heart failure（P0.05）were more common with delayed angiography. Delayed angiography was associated with better outcomes than that in no angiography （P0.05）. No delayed angiography was far better outcomes than that in no angiography（P0.01）. MACE rates after six months of following were higher with longer delay-to-angiography but no significantly difference（P0.05）. Angiography of all was associated with better than no angiography（P0.05）.After adjustment for gender,age, BMI, smoking, previous myocardial infarction, history of renal insufficiency, hypertention, diabetes, hyperlipidaemia, previous PCI, previous CABG and GRACE risk score, the difference in all groups was still existed. Conclusion： High-risk NSTE-ACS is suboptimally managed with not undergoing angiography. Longer delays are more likely with higher risk in short time. These delays are associated with adverse outcomes for example MACE, at six months. The trials these recommendations are based upon utilised an early invasive strategy performed in high-risk NSTE-ACS patients.