急诊介入治疗在非ST段抬高的急性冠状动脉综合征中的价值

目的　评价非ST段抬高急性冠状动脉综合征 (ACS)患者急诊介入治疗与药物治疗的疗效差异。方法　收治我院心内科的非ST段抬高的ACS患者共 86例 ,按治疗方法不同分为药物治疗组和急诊介入治疗组。急诊介入治疗组共 4 6例 ,在药物治疗基础上于发病后 12小时内行急诊介入治疗 ,所有血管病变均予治疗 ,其中 16例同时接受非病变血管治疗。药物治疗组 4 0例 ,按常规药物治疗。随访对比两组病例的心源性死亡率 ,急性心肌梗死率 (主要终点 ) ;心绞痛复发率及再入院率 (次要终点 )。结果　在平均 ( 10 6± 6 4 )个月随访中 ,急诊介入治疗组心源性死亡率低于药物治疗组 ( 4 3%比 7 5 % ,P >0 0 5 ) ,心绞痛复发率也明显低于药物治疗组 ( 2 1 7%比 5 2 5 % ,P <0 0 1)。结论　急诊介入治疗可显著改善非ST段抬高急性冠状动脉综合征患者预后。

The Value of Primary Percutaneous Coronary Intervention on Acute Coronary Syndromes

Objective To evaluate the efficacy and feasibility of primary percutaneous coronary intervention (PPCI) on acute coronary syndromes(ACS). Methods During 2000.1_2003.6,86 patients with non_ST_segment elevation ACS were divided into two groups (conservative and PPCI group) according to management strategy. 46 patients in PPCI group were treated with PPCI within 12 hours after onset. All "culprit" lesions in PPCI group were treated. "non_culprit" lesions of 16 patients in PPCI group were also treated at same time. There were 40 patients in conservative group. All patients in both groups were followed up. Cardiac death and acute myocardial infarction were the primary endpoint. Recurrence angina and readmission were the secondary endpoint. Results During the period of follow_up (mean 10 6±6 4 months),the rate of cardiac death was lower in primary PPCI group than in conservative group,but the difference had no significant (4 3% Vs 7 5%, P >0 05). The rate of recurrent angina was significantly lower in PPCI group than that in conservative group (21 7% Vs 52 5%, P <0 01) Conclusions PPCI could improve the prognosis of the patients with non_ST_segment elevation ACS.