中国非ST段抬高急性冠脉综合征抗凝治疗多中心观察研究

Anticoagulants for the treatment of non-ST-segment elevation acute coronary syndrome in China:a multi-center observational study

目的探讨中国非ST段抬高急性冠脉综合征(NSTE-ACS)抗凝治疗策略,为改善NSTE-ACS患者预后提供依据。方法以2009年12月至2011年12月中国14个省市的28家三级医院收治的1502例NSTE-ACS患者为受试对象,各中心自行决定诊疗策略,分析和比较受试对象的治疗用药、介入治疗、术后第9天和第30天的疗效终点和安全终点的发生情况等。结果不稳定型心绞痛(UA)组主要疗效终点事件和主要安全终点事件的发生率均显著低于非ST段抬高心肌梗死(NSTE-MI)组(P<0.05);普通肝素、低分子肝素和磺达肝癸钠的应用率分别为0.61%、66.42%和30.61%;介入治疗比例为69.64%;单纯用药比例为70.74%。结论 UA与NSTE-MI相比,预后较优,严重程度较低,两种分型的转归具有差异,但治疗方案无差异,在临床治疗中应当引起重视;中国当前NSTE-ACS的抗凝治疗以低分子肝素为主,多采用单纯用药、介入治疗。

Objective To assess the anticoagulation treatment for non-ST-segment elevation acute coronary syndromes （NSTE-ACS） in China and to offer rationale for establishing reasonable strategies to improve the prognosis of NSTE-ACS. Methods A total of 1502 patients with NSTE-ACS were recruited from different research centers in China. The strategies for diagnosis and treatment depended on researchers＇ decision in respective center, for further analysis and comparison on medicine care, percutaneous coronary intervention （PCI） therapy and end-points for efficacy and safety assessment at days 9 and 30 following PCI. Results A higher incidence rate （ P 〈 0. 05 ） was noted for efficacy and safety in patients with unstable angina （UA） than those with non-ST segment elevation myocardial infarction （NSTE-MI）. The rate of prescription was 0. 61% ,66. 42% ,30. 61% ,69. 64% and 70. 74% for unfractionated heparin （UFH）, low-molecular-weight hcparin （LM- WH） ,fondaparinux, PCI and pure medication ,respectively. Conclusion Compared with NSTE-MI, UA is featured by preferable prognosis and minor disease severity. The difference in treatment protocol, but not in the prognosis, was significant between the two phenotypes and warrants physicians＇ alert. The treatment of NSTE-ACS should be mainly based on LMWH, with pure medication and PCI as major adjuvant therapeutic approaches.