高危非ST段抬高急性冠脉综合征冠脉介入时机选择的研究进展

esearch progress and prospect on timing of high-risk NSTE-ACS coronary intervention

急性冠状动脉(下称冠脉)综合征(ACS)包括ST段抬高心肌梗死(STEMI)和非ST段抬高ACS(NSTE-ACS)。欧洲心脏病学会(ESC)根据危险分层将NSTE-ACS患者分为极高危、高危和低危。“2020年ESC NSTE-ACS指南”推荐极高危患者行即时(<2 h)介入治疗,高危患者行早期(<24 h)介入治疗,低危患者择期(>24 h)后考虑是否进一步介入诊疗。研究显示早期介入治疗可降低高危NSTE-ACS患者心血管不良事件发生风险,但对该类患者是否应采取更早期介入治疗存在争议。本文就即时介入、早期介入、择期介入对高危NSTE-ACS患者预后的影响作一述评。

Objective Acute coronary disease includes ST-segment elevation myocardial infarction(STEMI)and non-ST-segment elevation ACS(NSTE-ACS).2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation stratifies the NSTE-ACS patients into the very high-,high-and low-risk groups according to the risk assessments,and recommends the very high-risk patients to receive immediate invasive strategy(<2 h),the high-risk patients to receive early invasive strategy(<24 h)and the low-risk patients to receive selective invasive strategy(>24 h).Previous studies have shown the early invasive strategy reduces the risk of cardiovascular adverse advents,however,it remains unclear whether the high-risk NSTE-ACS patients should be treated with earlier invasive strategy.Therefore,this review attempts to address the effect of immediate,early and selective invasive strategy on high-risk NSTE-ACS patients.