早期有创干预对高危无ST段抬高急性冠状动脉综合征近远期预后的影响

目的探讨早期有创干预对高危无ST段抬高急性冠状动脉综合征(ACS)患者的近远期预后影响。方法2001年10月至2003年10月期间连续入院的无ST段抬高ACS患者545例,随机分成早期保守治疗组(284例)与早期有创干预组(261例),随访患者30d与6个月的复合心血管事件(包括心脏性死亡、非致命性心肌梗死、非致命性心力衰竭、因反复缺血性心绞痛发作住院),评价早期有创干预对肌钙蛋白(Tn)Ⅰ或高敏感C反应蛋白(hs-CRP)水平增高的高危患者近、远期预后的影响。结果与早期保守治疗组比较,早期有创干预降低随访30d时的反复心绞痛发作住院事件及随访30d与6个月时的复合心血管事件(P值均<0·05);亚组分析示早期有创干预可明显降低TnI增高或hs-CRP增高患者30d及6个月的复合心血管事件及6个月硬性终点事件发生率(均P值<0·01),对TnI或hs-CRP水平正常者,早期有创干预无明显优势。结论早期有创干预能明显降低TnI或hs-CRP水平增高的高危患者的心血管事件,改善患者的近、远期预后。

The effect of early invasive strategy on early and late outcomes in high-risk non-ST-segment elevation acute coronary syndromes

Objective To investigate the effect of early invasive strategy on early and late outcomes in high-risk patients with non-ST-segment elevation acute coronary syndromes(ACS). Methods Five hundred and forty-five patients of ACS without ST-segment elevation were randomly assigned to an early conservative strategy (284 cases) or early invasive strategy group(261 cases), who were enrolled consecutively from Oct.,2001 to Oct.,2003. The combined cardiovascular events(a combination of cardiac death, nonfatal myocardial infarction, nonfatal heart failure and hospital readmission due to recurrent ischemic angina ) within 30 days and 6 months were analyzed and the effects of early invasive strategy on early and late outcomes in high-risk patients with increased TnI or hs-CRP levels were evaluated. Results As compared with early conservative strategy, early invasive strategy lowered the rate of hospital readmission due to recurrent ischemic angina of 30 d and the combined cardiovascular events of 30 d and 6 months(all P<0.05). Subgroup analysis indicated early invasive strategy could significantly decrease the incidences of the combined cardiovascular events of 30 d and 6 months and the hard end point events of 6 months in patients with increased TnI or hs-CRP levels(all P<0.01), but no such changes could be seen in patients with normal TnI or hs-CRP levels, as compared with early conservative strategy. Conclusions Early invasive strategy decreases significantly cardiovascular events and improves the early and late outcomes in high-risk patients with increased TnI or hs-CRP levels.