ACS冠状动脉闭塞与非闭塞临床特征及院内预后的比较研究

Comparison of clinical characteristics and in-hospital prognosis of coronary occlusion vs non-occlusion in patients with acute coronary syndrome

目的:探讨急性冠状动脉综合征(ACS)患者冠状动脉(冠脉)闭塞与非闭塞的临床特征及院内预后差异。方法:将ACS患者分为冠脉闭塞组及冠脉非闭塞组,收集患者的临床资料并进行统计分析。结果:共有ACS患者592例,其中66例(11%)继发性ACS患者被排除,最后526例患者(闭塞组303例,非闭塞组223例)纳入分析。与冠脉闭塞组相比,非闭塞组胸痛时间(20.87±57.74) h∶(10.38±11.58) h、收缩压(128.15±25.02) mmHg∶(122.06±23.57) mmHg、血脂异常(18%∶11%)、阿司匹林(96%∶87%)、P2Y12抑制剂(96%∶87%)、他汀类药物(97%∶90%)、β受体阻断剂(74%∶63%)、左室射血分数(EF)(50.68±11.05)%∶(46.98±11.12)%、LAD病变(62%∶45%)及输血(2%∶0)更高,均P<0.05;而Mb(408.24±617.75) ng/L∶(628.22±755.60) ng/L、RCA病变(19%∶38%)、PTCA(2%∶7%)、血栓抽吸(6%∶21%)、替罗非班(60%∶79%)、支架直径(3.07±0.48) mm∶(3.16±0.45) mm、全因死亡(0∶5%)、再次心梗(0∶3%)、心力衰竭(4%∶12%)、心源性休克(4%∶9%)及全因事件(16%∶32%)更低,均P<0.05。结论:与冠脉闭塞患者相比,冠脉非闭塞的ACS患者胸痛时间、收缩压、血脂异常病史、药物使用(阿司匹林、P2Y12抑制剂、他汀类药物及β受体阻断剂)及LAD病变更高,院内预后更好。

Objective:To investigate clinical characteristics and in-hospital prognosis of coronary occlusion and non-occlusion in patients with acute coronary syndrome(ACS).Method:According to the condition of coronary occlusion,patients with ACS were divided into coronary occlusion group and non-occlusion group.Statistical analysis was performed by collecting general clinical data,laboratory examination,coronary imaging and in-hospital adverse events.Result:There were 592 patients with ACS were included,66(11%)with secondary ACS were excluded.Finally,526 patients(303 in the occlusion group and 223 in the non-occlusion group)were included in the analysis.Compared with the coronary occlusion group,chest pain time(20.87±57.74 vs 10.38±11.58)h,systolic blood pressure(128.15±25.02 vs 122.06±23.57)mmHg,dyslipidemia(18 vs 11)%,aspirin(96 vs 87)%,P2 Y12 inhibitor(96 vs 87)%,statin(97 vs 90)%,beta blocker(74 vs 63)%,left ventricular ejection fraction(EF)(50.68±11.05 vs 46.98±11.12)%,LAD lesions(62 vs 45)%and blood transfusion(2 vs 0)%with non-total occlusion group were higher,P<0.05,while Mb(408.24±617.75 vs 628.22±755.60)ng/L,RCA lesions(19 vs 38)%,PTCA(2 vs7)%,thrombus aspiration(6 vs 21)%,tirofiban(60 vs 79)%,stent diameter(3.07±0.48 vs 3.16±0.45)mm,all-cause Death(0 vs 5)%,recurrent MI(0 vs 3)%,heart failure(4 vs 12)%,cardiogenic shock(4 vs9)%,and all-cause events(16 vs 32)%with non-total occlusion group were lower compared with the coronary occlusion group,P<0.05.Conclusion:Time of chest pain,systolic blood pressure,dyslipidemia,drug use(aspirin,P2 Y12 inhibitor,statin,and beta blocker),LAD lesions have a higher rate and in-hospital adverse events are fewer in ACS patient with non-total occlusion of coronary artery compared with the coronary occlusion patients.