OUTCOMES OF INVASIVE STRATEGY TO PATIENTS WITH NON-ST-ELEVATION ACUTE CORONARY SYNDROMES

摘要

Objective To compare the outcomes of an invasive with a conservative strategy in the management of patients with non-ST-elevation acute coronary syndromes. Methods From January 2000 to June 2001,505 patients presenting with unstable angina or non-Q wave myocardial infarction were divided into two groups (conservative vs. invasive) according to management strategy. Patients assigned to an early invasive strategy underwent coronary angiography within 7d of enrollment after intensive antiplatelet, antithrombotic and antiangina therapy and revascularization as appropriate. All patients were followed up at least 6 months. The primary endpoints were cardiac death and acute myocardial infarction. Recurrence angina and readmission were the secondary endpoint. Results There were 194 patients in conservative group and 311 patients in invasive group. Overall, coronary angiography was performed in 100% and 56%, and revascularization in 93% and 52% in the invasive and conservative groups, respectively. During a mean of 11 + 5. 7 months ( range 6 ～ 24 months) of follow-up, the occurrence of primary endpoint was significantly lower in the invasive group than that in the conservative group (3. 9% vs 8. 2%, P =0. 036). The rate of recurrent angina (48% vs 17%, P =0. 001 ), readmission (41% vs 13%, P =0. 001 ) and revascularization ( 12% vs 35%, P =0. 001 ) was also significantly lower in patients assigned to invasive strategy. Conclusion The study indicates that the early invasive approach may be the preferred strategy in patients with unstable angina or non-Q wave myocardial infarction.