不同时间段介入治疗非ST段抬高急性冠状动脉综合征的近期疗效Analysis of hospital outcomes of early and delayed PCI in non-ST segment elevation ACS
黄莺,马依彤,杨毅宁,汤宝鹏,木胡牙提,张燕一,王疆
摘要(Abstract)：
目的 比较发病后不同时间段介入治疗非ST段抬高急性冠状动脉 (冠脉 )综合征的近期疗效以确定早期介入治疗的时间窗。方法 选择 2 0 0 1年 1月至 2 0 0 4年 6月间进行介入治疗的非ST段抬高急性冠脉综合征患者 15 0例 ,根据介入治疗开始的时间分为发病后 <2 4h ,2 4～ 72h和 >72h组 ,比较各组的冠脉介入治疗成功率 ,术后胸痛缓解率 ,术后血流TIMI分级改善率 ,术中、术后并发症发生率 ,住院天数的长短。结果 各组间PCI成功率、术后胸痛缓解率、术后血流TIMI分级改善率均无明显差异。术中并发症 <2 4h组较其他组明显高 (2 3 3%比 8 3% ,P <0 0 5 )。结论 非ST段抬高的急性冠脉综合征患者不同时间介入治疗在院期间的近期疗效是相当的 ,但 <2 4h组术中并发症发生率高 ,从安全性及效价比的角度考虑 ,2 4～ 72h为非ST段抬高的ACS早期介入治疗较为合适的时间选择。
关键词(KeyWords)： 急性冠状动脉综合征;血管成形术,经腔,经皮冠状动脉
基金项目(Foundation):
作者(Author): 黄莺,马依彤,杨毅宁,汤宝鹏,木胡牙提,张燕一,王疆
参考文献(References)：
- 1CannonCP ,SeintraubWS ,DemopoulousLA ,etal.InvasiveversusconservativestrategiesinunstableanginaandnonQwavemyocardialinfarctionfollowingtreatmentwithtirofiban:rationaleandstudydesignoftheinternationalTACTICS TIMI 18Trail.TreatAnginawithAggrastatanddetermineCostofTherapywithanInvasiveorConservativeStrategy.ThombolysisinMyocardialInfarction.AmJCardiol,1998,352:507514.
- 2SpacekR ,WidimiskyP ,StrakaZ ,etal.Valueoffirstdayangiography angioplastyInvolvingnonSTsegmentelevationmyocardialinfarction:Anopenmulticenterrandomizedtrail.TheVINOStudy.EurHeartJ ,2002,23:230238.
- 3SabatineMS ,AntmanEM .Thethrombolysisinmyocardialinfarctionriskscoreinunstableangina nonST segmentelevationmyocardialinfarction.JAmCollCardiol,2003,41(4SupplS):S8995.
- 4AndersonHV ,CannonCP ,StonePH ,etal.One yearresultsofTheThrombolysisinMyocardialInfarction(TIMI)IIIBclinicaltrial:arandomizedcomparisonoftissue typeplasminogenactivatorversusplaceboandearlyinvasiveversusearlyconservativestrategiesinunstableanginaandnonQwaveMycardiolInfarction.JAmCollCardiol,1995,26:16431650.
- 5AlfonsoF ,MacayaC ,IguesA ,etal.PercutaneoustransluminalcoronaryangioplastyafternonQ waveacutemyocardialinfartion.AmJCardiol,1990,65:835839.
- 6GibsonCM .Thetime dependentopenvascularhypothesis.CardioRounds,2000,4:1015.
- 7RoonerE ,BoersmaE ,LaarmanGJ,etal.EarlyangioplastyinacutecoronarysyndromeswithoutpersistentST segmentelevationimprovesoutcomebutincreasestheneedforsix monthrepeatrevascularization:ananalysisofthePURSUITtrail.PlateletglycoproteinⅡbⅢainUnstableangina:ReceptorSupressionUsingIntergrilinTherapy.JAmCollCardiol,2002,39:19241929.