急性冠状动脉综合征患者血运重建的预后

The clinical outcomes of patients undergoing revascularization for acute coronary syndrome

目的了解接受血运重建治疗的急性冠状动脉综合征患者的近期和长期预后。方法入选2003年7月1日至2005年9月30日在我院接受血运重建治疗的6005例患者，1年后对患者进行电话或门诊随访。比较ST段抬高心肌梗死（STEMI）、非ST段抬高急性心肌梗死（NSTEMI）和不稳定性心绞痛患者的临床和预后[不良心脑血管事件（MACCE）包括全因死亡、非致死性心肌梗死、非致死性卒中和再次血运重建]情况。结果共4865例患者，其中STEMI患者955例，NSTEMI患者263例，不稳定性心绞痛患者3647例，3组患者的院内和18个月生存率（分别为96％、98％和98％）差异无统计学意义，不稳定性心绞痛患者18个月MACCE发生率较低（STEMI，NSTEMI和不稳定性心绞痛3组无事件生存率分别为86％、86％和89％）。结论接受血运重建的STEMI、NSTEMI和不稳定性心绞痛患者临床情况有所差异，但是近期和长期病死率相似，不稳定性心绞痛患者的长期MACCE发生率低。

Objective To evaluate short-term and long-term prognosis of revascularization in patients with acute coronary syndrome. Methods A total of 6005 patients who received coronary revascularization in our institution between July 2003 and September 2005 were enrolled. The patients were followed up in clinic or by telephone after discharge between September 2006 and November 2006. The clinical and prognosis data of all-cause mortality, neo-myoeardial infarction, nonfatal stroke, and rerevasenlarization of ST-segment elevation myocardial infarction （STEMI）, non ST-segment elevation myocardial infarction （NSTEMI） and major adverse cardiovascular and cerebrovascular events （MACCE） were analyzed. Results Among 4865 acute coronary syndrome patients, 955 cases were STEMI ; 263 cases were NSTEMI; and 3647 cases were unstable angina （UA） peetoris. There were no significant difference for in-hospital mortality and late mortality （18 month survival 96%, 98% and 98% ） between patients with STEMI, NSTEMI and UA. Patients with UA had lower MACCE rate （18 month non-MACCE survival of STEMI, NSTEMI and UA group were 86% , 86% , and 89% respectively）. Conclusions Despite different clinical characteristics, patients with STEMI, NSTEMI and UA undergoing revascularization had similar short-term and long-term mortality. Patients with UA had lower MACCE rate.