不同危险分层的不稳定型心绞痛及非ST段抬高心肌梗死患者的治疗现状和近期预后

Therapeutic status and short-term prognosis in unstable angina or non-ST segment elevation myocardial infarction patients with different risk stratification

目的:了解我院不同危险分层的不稳定型心绞痛及非 ST段抬高心肌梗死(UA/NSTEMI)患者的临床及治疗情况,并探讨危险分层与院内不良事件之间的关系。方法:本研究的资料来源于 SUNDAY(TheStrategies for UA/NSTEMI and Delay of AngioplastY Registry)研究,SUNDAY研究回顾性注册登记了 2000 年1月至2002年12月3年间首次因 UA/NSTEMI住院的患者,记录了患者临床、血清学及药物治疗情况,根据2002年ACC/AHA的UA/NSTEMI指南进行危险分层,同时还记录院内不良事件。主要终点事件定义为全因死亡,2级复合终点事件为死亡或MI。结果:符合入选标准者共1013 例,男 713 例,女 300 例,平均年龄(61.6±10.4)岁,UA患者956例(94.4%),NSTEMI患者57例(5.6%)。高危组患者的年龄明显高于中危组和低危组,男性的比例低于中危组和低危组。在高危组中,50.7%的患者应用了低分子肝素,明显高于中危(32.4%, P<0.01)和低危组(26.2%,P<0.01)。高危组β受体阻滞剂和他汀类药物的使用率明显高于低危组和中危组。低危组患者行冠状动脉造影的比例(98.1%)高于中危组(91.4%,P<0.01)和高危组(79.8%,P<0.01)。不同危险分层患者住院期间主要终点事件的发生率无明显差别,低、中、高危三组分别为 0%、1.0%、1.5%;2 级复合终点事件3组分别为1.9%、3.8%。

Objective:To analyze the difference of clinical and medical status in unstable angina / non-ST segment elevation myocardial infarction (UA/NSTEMI) patients with different risk stratification through retrograde methods, and explore the relationship between stratification and in-hospital adverse events. Method: The investigation, enrolled 1013 patients with UA/NSTEMI from 2000 to 2002, derived from SUNDAY(The Strategies for UA/NSTEMI and Delay of AngioplastY Registry)study. The demographic and clinical characteristics, serum test, medicine therapy and in-hospital adverse events were recorded. Risk stratification was made according to ACC/AHA guidelines of UA/NSTEMI. Primary endpoint was defined as all-cause death and secondary endpoints were defined as a composite of all-cause death or myocardial infarction. Result:The study included 956 UA patients and 57 NSTEMI, with mean age of ( 61.6± 10.4), among them 103 in low-risk group, 500 in moderate-risk group,and 410 in high-risk group. The patients in high risk group were older ( 63.7± 11.0)than those in moderate-risk group ( 60.9± 9.5,P< 0.01) and low-risk group ( 56.4± 9.6,P< 0.01). The utilization of anti-platelet agents and ACE inhibitor was not different significantly in the groups. The frequency of low-molecule-weight-heparin, beta-blocker and statins was higher in high-risk group than that in moderate and low risk group. The patients undergoing angiography in low-risk group ( 98.1%) were more than in moderate-risk ( 91.4%,P< 0.001) and high-risk groups ( 79.8%,P< 0.01). The differences of in-hospital adverse events were not significant in the groups. Conclusion:The utilization of low-molecular-weight-heparin、beta-blocker and statins in high-risk group with UA/NSTEMI was more than in low-risk and moderate-risk groups. The invasive strategy and revascularization therapy were higher in low and moderate groups than in high-risk group .The differences of in-hospital adverse events between each group were not significant.