早期介入治疗对高危非ST段抬高型急性冠状动脉综合征患者12个月临床结果的影响

摘要

目的 比较早期经皮冠状动脉介入(PCI)与延迟PCI策略对高危非ST段抬高型急性冠状动脉综合征(NSTE-ACS)12个月临床终点的影响.方法 连续收集自2015年1月1日至2015年12月31日在武汉亚洲心脏病医院行PCI治疗的高危NSTE-ACS患者758例,并依据介入治疗时间窗分为早期PCI组(确诊后24 h内PCI,185例)和延迟PCI组(确诊后超过24 h PCI,573例),主要终点是术后12个月主要不良心血管事件(MACE),包括全因死亡与再发非致死性心肌梗死.回顾性对比分析两组基线临床资料、冠状动脉影像特征、PCI相关数据以及主要终点.结果 711例(93.8%)患者完成12个月随访.早期PCI组主要终点MACE发生率与延迟PCI组比较差异无统计学意义(14.5%比11.2%,χ2=1.289,P=0.256),全因死亡与再发非致死性心肌梗死两组比较,差异均无统计学意义(均P>0.05).早期PCI组显著降低住院时间[(7.6±3.1)d比(10.7±3.8)d,t=2.489,P=0.014)]及减少医疗费用[(4.85±1.35)万元比(5.28±1.64)万元,t=2.132,P=0.038)]与延迟PCI组比较,差异均有统计学意义.结论 早期介入干预不能降低高危NSTE-ACS患者PCI术后12个月MACE发生率,但能缩短住院时间,减少医疗费用.%Objective To compare 12-month follow-up clinical outcome of an early to a delayed intervention in the management of high-risk non-ST elevation acute coronary syndrome (NSTE-ACS) patients. Methods 758 consecutive high-risk NSTE-ACS patients treated with percutaneous coronary artery intervention(PCI)were enrolled between Jauary 2015 and December 2015 in Wuhan Asia Heart Hospital. They were divided into 2 groups according to diff erent intervention time, the early PCI group(within 24 h after diagnosis,n=185)and the delayed group (more than 24 h after diagnosis, n=573).The baseline clinical data, angiographic features, data related to PCI, the 12-month follow-up major adverse cardiac events (MACE) were analyzed retrospectively. MACE were defi ned as all-cause death and recurrent nonfatal myocardial infarction. Results Primary endpoint status after 12-month follow-up were collected in 711 of 758 initially enrolled patients. Incidence of MACE was 14.5% in the early and 11.2% in the delayed PCI group(χ2=1.289,P=0.256). No signifi cant diff erences were found in the occurrence of the individual components of all-cause death and nonfatal myocardial infarction. Mean hospital stay were(7.6±3.1)d in the early and (10.7±3.8)d in the delayed PCI group(t=2.489,P=0.014). Mean medical expenses in RMB were(48.5±13.5) thousand yuan in the early and(52.8±16.4)thousand yuan in the delayed PCI group(t=2.132,P=0.038). Conclusions After 12-month follow-up,no diff erence in incidence of MACE was seen between early and delayed invasive strategy,but with shorter hospital stay and reduced medical expenses.