心肌梗死溶栓试验危险评分对无ST段抬高急性冠状动脉综合征患者不同干预策略的影响

目的探讨心肌梗死溶栓试验（TIMI）危险评分对无ST段抬高急性冠状动脉综合征（ACS）患者不同干预策略的影响。方法将2001年10月至2003年10月期间连续入院的无ST段抬高ACS患者共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）,并根据TIMI危险评分分为低分组、中分组和高分组,随访30天与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、反复缺血性心绞痛发作住院事件）,评价不同TIMI危险评分对两种干预策略疗效的影响。结果早期有创干预组的随访30天反复心绞痛发作住院事件3．5％（9／261）]及30天与6个月复合心血管事件分别为10．0％（26／261）,21．1％（55／261）]低于随访同时期的早期保守治疗组分别为8．1％（23／284）、16．9％（48／284）和28．2％（80／284）,均P〈0．05];早期有创干预组随访30天TIMI危险评分高分组12．2％（5／41）]和随访6个月的高分组及中分组患者的复合心血管事件发生率22．0％（9／41）,12．7％（20／158）]明显低于随访同时期保守治疗组随访30天高分组37．3％（19／51）;随访6个月高分组74．5％（38／51）,中分组30．4％（49／161）;均P〈0．01];在TIMI危险评分低分组中两种治疗对策对心血管事件的影响差异无统计学意义。结论在TIMI危险评分高及中分组无ST段抬高ACS患者中,早期有创干预较早期保守治疗策略能明显降低复合心血管事件、改善预后;对TIMI危险评分低分组者,两种干预策略的疗效无明显著别。

The relationship between TIMI (thrombolysis in myocardial infarction) risk score and efficacy of conservative or interventional strategy in patients with non-ST-segment elevation acute coronary syndromes

Objective To investigate the relationship between thrombolysis in myocarolial infarction(TIMI)risk score and efficacy of different treatment strategies in patients with non-ST-segment elevation acute coronary syndromes(NSTE-ACS).Methods From Oct.2001 to Oct.2003,545 consecutive patients with NSTE-ACS were randomly assigned to early conservative strategy(n=284)or early invasive strategy group(n=261).The combined cardiovascular events(a combination of cardiac death,nonfatal myocardial infarction,nonfatal heart failure and re-hospital admission due to recurrent ischemia angina)within 30 days and 6 months were analyzed and related to the TIMI risk score at admission.Results Rehospitalization due to recurrent ischemia angina of 30 days and the combined cardiovascular events of 30 days and 6 months were significantly lower in early invasive strategy group(3.5%,10.0%,21.1%)compared with early conservative strategy group(8.1%,16.9%,28.2%,all P<0.05).Subgroup analysis indicated early invasive strategy could significantly decrease the 30 d incidence of the combined end point events in patients with high TIMI risk score and the 6 months incidence of the combined end point events in patients with moderate and high TIMI risk score(all P<0.01),but the incidence was similar between the two different strategies in patients with low TIMI risk score.Conclusions Early invasive strategy may significantly reduce combined cardiovascular events in NSTE-ACS patients with moderate and high TIMI risk score compared with early conservative strategy.