非ST段抬高型心肌梗死早期治疗策略的对比研究

Comparison of early treatment strategies for non-ST-segment elevation myocardial infraction

目的有关非ST段抬高急性冠状动脉综合症早期治疗策略的选择存在很大争议,高危患者的早期行介入治疗未受重视,文中回顾性分析比较急性非ST段抬高型心肌梗死患者早期介入治疗和保守治疗的临床疗效。方法急性非ST段抬高型心肌梗死患者共142例,按早期治疗策略的不同分为早期保守治疗组(60例)和早期介入治疗组(82例),早期介入治疗组行冠状动脉造影检查,并根据造影结果选择进一步血运重建术,随访患者(至少6个月)心源性死亡率和(或)非致死性心肌梗死的发生率(主要终点),包括死亡、心肌梗死、再次血运重建、因心绞痛再入院的联合终点事件的发生率(次要终点)。结果在6个月的随访中,早期介入治疗组主要终点事件的发生率显著低于早期保守治疗组(7%vs23%,P=0.007),病死率也显著降低(5%vs20%,P=0.005),2组患者发生心肌梗死的差异无统计学意义;联合终点事件(27%vs37%,P=0.211)2组差异无统计学意义。结论急性非ST段抬高型心肌梗死患者早期行介入治疗可改善患者预后,显著降低患者病死率。

Objective Controversies exist over the early treatment strategies for non-ST-segment elevation acute coronary syndromes,and early invasive treatment has been neglected,especially in high risk patients.The paper was to evaluate and compare the clinical efficacies of early invasive and early conservative strategies in the treatment of non-ST-segment elevation myocardial infraction.Methods A total of 142 patients with non-ST-segment elevation myocardial infraction were divided into an early conservative group(n = 60) and an early invasive group(n = 82).The latter underwent coronary angiography and revascularization before discharge.All the patients were followed up for at least 6 months for the rates of the primary endpoint events as cardiac death and/or nonfatal myocardial infraction,and the secondary composite endpoint events as cardiac death,nonfatal myocardial infraction,revascularization or rehospitalization.Results During the 6 months of follow-up,the rate of primary endpoint events was significantly lower in the early invasive group than in the conservative group(7% vs23%,P=0.007),and so was the rate of cardiac death(5% vs 20%,P=0.005),while the rate nonfatal myocardial infraction was similar in the two groups.No significant difference was found in the rate of composite endpoint events between the two groups(27% vs37%,P=0.211).Conclusion Early invasive strategy can improve prognosis and significantly reduce mortality for patients with acute non-ST-segment elevation myocardial infraction.