尽管急性冠状动脉综合征（不稳定型心绞痛/非ST段抬高型心肌梗死）患者的心肌梗死溶栓治疗（TIMI）风险评分相似，但住院结局仍有所改善。

Improved in-hospital outcomes in acute coronary syndromes (unstable angina/non-ST segment elevation myocardial infarction) despite similar TIMI risk scores.

作者信息

Almeda Francis Q, Hendel Robert C, Nathan Sandeep, Meyer Peter M, Calvin James E, Klein Lloyd W

机构信息

Rush-Presbyterian-St. Luke's Medical Center, Rush Heart Institute, Chicago, IL, USA.

出版信息

J Invasive Cardiol. 2003 Sep;15(9):502-6.

PMID:12947210

Abstract

BACKGROUND

The Thrombolysis In Myocardial Infarction (TIMI) Risk Score has been shown to predict prognosis in acute coronary syndromes (ACS) comprised of unstable angina (UA) and non-ST segment elevation myocardial infarction (STEMI). We sought to evaluate the impact of newer antiplatelet and antithrombotic therapies for ACS, such as glycoprotein IIb/IIIa inhibitors (GPI) and low molecular weight heparin (LMWH), on in-hospital outcomes over time in patients (pts) with similar TIMI risk scores.

METHODS

The baseline demographics and clinical outcomes of pts with ACS (UA and non-STEMI) in 1998 (Group 1998) and 2000 (Group 2000) at a single large university medical center were compared using a prospectively collected database. In-hospital major adverse cardiac events (MACE) included death, MI, or recurrent angina that resulted in urgent revascularization. Risk was estimated by utilizing the TIMI Risk Score, which uses 7 predictor variables: age > 65 years, at least 3 risk factors for coronary artery disease, prior coronary stenosis of 50%, ST segment deviation on EKG, severe angina, prior aspirin use, and elevated cardiac biomarkers.

RESULTS

Comparing Group 1998 (n = 563) and Group 2000 (n = 604), there was no difference between the mean TIMI Risk Score (2.90 1.52 vs. 2.91 1.52; p = 0.97), demonstrating a similar risk profile. Nevertheless, significant improvement in in-hospital MACE (9.1% vs. 2.8%; p < 0.001) was noted. The improvement in MACE was due to differences in rates of recurrent angina, without significant differences in death and myocardial infarction. This occurred temporally in association with a significant increase in GPI (1.0% vs. 8.3%; p < 0.01) and LMWH (0.0% vs. 15.6%; p < 0.001) use within 24 hours of presentation, and the increased utilization of intracoronary stenting (46.6% vs. 64.6%; p = 0.005), findings which were confirmed with multivariate analysis.

CONCLUSION

Despite similar TIMI Risk Scores, the in-hospital outcomes of pts with ACS have improved over time. This temporal change is associated with the greater use of newer antiplatelet and antithrombotic therapies and increased utilization of intracoronary stenting.

摘要

背景

心肌梗死溶栓（TIMI）风险评分已被证明可预测由不稳定型心绞痛（UA）和非ST段抬高型心肌梗死（NSTEMI）组成的急性冠状动脉综合征（ACS）的预后。我们试图评估新型抗血小板和抗血栓治疗，如糖蛋白IIb/IIIa抑制剂（GPI）和低分子量肝素（LMWH），对具有相似TIMI风险评分的患者住院期间结局随时间的影响。

方法

使用前瞻性收集的数据库比较了1998年（1998组）和2000年（2000组）在一所大型大学医学中心的ACS（UA和NSTEMI）患者的基线人口统计学和临床结局。住院期间主要不良心脏事件（MACE）包括死亡、心肌梗死或导致紧急血运重建的复发性心绞痛。通过使用TIMI风险评分来估计风险，该评分使用7个预测变量：年龄>65岁、至少3个冠状动脉疾病危险因素、既往冠状动脉狭窄50%、心电图ST段偏移、严重心绞痛、既往使用阿司匹林以及心脏生物标志物升高。

结果

比较1998组（n = 563）和2000组（n = 604），平均TIMI风险评分无差异（2.90±1.52 vs. 2.91±1.52；p = 0.97），表明风险特征相似。然而，住院期间MACE有显著改善（9.1% vs. 2.8%；p < 0.001）。MACE的改善归因于复发性心绞痛发生率的差异，死亡和心肌梗死无显著差异。这在时间上与就诊后24小时内GPI使用显著增加（1.0% vs. 8.3%；p < 0.01）和LMWH使用增加（0.0% vs. 15.6%；p < 0.001）以及冠状动脉内支架置入的使用增加（46.6% vs. 64.6%；p = 0.005）相关，多变量分析证实了这些发现。