不同时间窗干预非ST段抬高型急性冠状动脉综合征疗效观察

目的 比较非ST段抬高型急性冠状动脉综合征患者早期干预和延迟干预的有效性和安全性.方法 本试验为多中心随机研究,将入选的非ST段抬高型急性冠状动脉综合征患者分配至早期组(24 h内接受冠状动脉造影)和延迟组(36 h后接受冠状动脉造影),接受介入治疗或冠状动脉旁路移植术.主要终点是180 d随访时死亡、心肌梗死、卒中的复合终点,次要终点是180 d随访时死亡、心肌梗死、难治性缺血、卒中、再次血运重建.结果 共有815例患者入选,主要终点事件发生率早期组为9.0%,延迟组为14.6%(P=0.01).次要终点事件(180 d死亡、心肌梗死或难治性缺血复合终点)的发生率早期组为14.6%,延迟组为22.0%(P=0.01).180 d心肌梗死发生率延迟组高于早期组(10.8%比5.2%,P=0.00).另一个次要终点事件(180 d死亡、心肌梗死、难治性缺血、卒中或再次血运重建复合终点)的发生率早期组为26.7%,延迟组为30.4%(P=0.25).结论 早期干预可以减少非ST段抬高型急性冠状动脉综合征患者再发心肌梗死的发生率.

Outcome of patients with non-ST segment elevation acute coronary syndrome undergoing early or delayed intervention

Objective To compare the effect and safety of early intervention and delayed intervention in patients with non-ST segment elevation acute coronary syndrome. Methods In this multicenter randomized trial, patients diagnosed as non-ST segment elevation acute coronary syndrome were randomly assigned to undergo early intervention (coronary angiography ≤ 24 hours after randomization, n =446 ) or delayed intervention ( coronary angiography ≥ 36 hours after randomization, n = 369 ). The primary outcome was a composite of death, myocardial infarction or stroke at 180 days. The secondary outcome was death, myocardial infarction, refractory ischemia, stroke or revascularization at 180 days. Results Baseline clinical characteristics were comparable between the two groups. Incidence of both primary (9.0% vs.14. 6%, P = 0. 01 ) and secondary which was a composite of death, myocardial infarction or refractory ischemia ( 14. 6% vs. 22. 0% P =0.01 ) endpoints were significantly lower in early intervention group than in delayed intervention group. Incidence of myocardial infarction was significantly lower in early intervention group than in delayed intervention group (5.2% vs. 10. 8% ,P =0. 00). Another secondary outcome which was a composite of death, myocardial infarction, refractory ischemia, stroke or revascularization was similar between the two groups (26. 7% vs. 30. 4%, P = 0. 25 ). Conclusion Compared to delayed intervention group, early intervention reduced incidence of myocardial infarction but did not affect the incidence of death,stroke or refractory ischemia in patients with non-ST segment elevation acute coronary syndrome.