非ST段抬高急性冠状动脉综合征患者的早期紧急介入治疗

Emergency percutaneous coronary intervention for non-ST-segment elevation acute coronary syndrom

目的评价非ST段抬高急性冠状动脉综合征(acute coronary syndrome,ACS)患者早期应用紧急经皮冠状动脉介入治疗(PCI)的临床疗效。方法2000年1月至2005年9月我院收治的385例中、高危非ST段抬高ACS患者,根据药物治疗后病情变化,分别在入院1~2 d内(233例,紧急介入组)或3~14 d(152例,延迟介入组)行冠状动脉造影(CAG)及PCI。所有“罪犯”病变均予治疗,介入方法有经皮冠状动脉腔内成形术(PTCA)+支架、直接置入支架等。观察两组手术成功率、心绞痛缓解时间、住院时间和PCI后30 d及6个月心源性死亡、心绞痛复发等不良心脏事件发生率。结果紧急介入组手术成功率与延迟介入组相似,分别为98.1%和95.5%(P>0.05),但入院至心绞痛缓解时间分别为(2.9±1.1)d和(6.0±3.6)d(P<0.05);住院时间分别为(9.7±4.3)d和(14.2±6.6)d(P<0.05);在住院期间,两组患者均无急性心肌梗死、猝死及心功能恶化发生。30 d随访期间紧急介入组总不良心脏事件发生率较延迟介入组明显减少,二者分别为2.9%和14.1%(P<0.01)。结论在条件具备的介入中心,由经验丰富和技术娴熟的介入治疗医生施行或在其指导下,对非ST段抬高ACS患者进行早期紧急介入治疗是积极、有效的治疗措施,近、远期临床效果较满意,手术成功率及安全性较高,可作为大多数非ST段抬高ACS患者的首选治疗策略。

Objective To evaluate the effficacy and safety of emergency percutaneous coronary intervention （PCI） in patients with non-ST-se^nent elevation acute coronary syndrome （ACS） . Methods A total of 233 patients （emergency group） were treated with emergency PCI within 48 h of heart attack and another 152 patients （delayed group） were treated with PCI after 3 - 14 days of medical therapy. All culprit lesions were treated. Procedural success rate, the time from admission to angina relief, the length of hospital stay and cardiac events incidence in 30 days were observed. Results The procedural success rates for the emergency group and the delayed group were similar （98.1% vs 95.5% ）, but cardiac events incidence in 30 days was significantly lower in the emergency group than that of the delayed group （2.9% vs 14.1%, P 〈 0.01 ）. The time from admission to angina relief （2.9 ± 1.1 days vs 6.0 ± 3.6 days） and the length of hospital stay （9.7 ± 4.3 days vs 14.2 ± 6.6 days） were significantly reduced in the emergency group （ P 〈 0.05）. During the follow-up of 30 days, 6 patients suffered from angina again in the emergency group while 15 patients suffered from refractory and 2 patients had sudden death in the delayed group （ P 〈 0.01 ）. Conclusion Emergency PCI is effective and safe for patients with non-ST-segment elevation ACS.