Al-Mallah Mouaz, Dajani Khaled, Hudson Michael, Iyengar Hrishikesh, Gutierrez Noel, Weaver W Douglas, Khanal Sanjaya
Interventional Cardiovascular Fellowship, Henry Ford Heart and Vascular Institute, Cardiac Cath Lab, K-2, 2799 West Grand Blvd., Detroit, MI, USA.
J Invasive Cardiol. 2005 May;17(5):251-5.
We investigated the impact of the duration from hospital admission to coronary angiography on the outcome of patients admitted with non ST-segment elevation acute coronary syndromes (NSTE-ACS).
Invasive risk stratification in patients with acute coronary syndromes (ACS) has been shown to improve outcome in contemporary studies. It is unclear whether early coronary angiography is better than initial medical therapy with later angiography.
We performed an analysis of patients admitted to a tertiary coronary intensive care unit (CICU) with NSTE-ACS and had coronary angiography performed during the same hospitalization. Patients were categorized into three groups based on the time-to-angiography: same-day, 1 to 2 days, and > 2 days. The baseline clinical features, angiography results, 30-day, 6-month cardiovascular outcome and 3-year mortality rate were compared between the groups before and after adjusting for confounding variables.
A total of 836 fulfilled the inclusion criteria. Patients undergoing angiography > 2 days had a higher incidence of 3-vessel disease (45.7% vs. 31.7%, p < 0.001), underwent less percutaneous interventions at the time of the angiography (41.6% vs. 56.7%, p < 0.001), and more frequent coronary artery bypass surgery (9.9% vs. 15.3%, p = 0.05). Patients undergoing late invasive risk stratification (> 2 days) had increased 3-year mortality (OR 2.12, 95% CI 1.03-4.35, p = 0.04) after adjusting for confounding variables.
In patients with NSTE-ACS and no contraindication to angiography, delayed angiography of more than 2 days of presentation was associated with increased mortality at 3 years.
我们研究了从入院到冠状动脉造影的时间对非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者预后的影响。
在当代研究中，急性冠状动脉综合征（ACS）患者的有创风险分层已被证明可改善预后。早期冠状动脉造影是否优于初始药物治疗后再进行造影尚不清楚。
我们对入住三级冠状动脉重症监护病房（CICU）且在同一住院期间进行冠状动脉造影的NSTE-ACS患者进行了分析。根据造影时间将患者分为三组：当日、1至2天、>2天。在调整混杂变量前后，比较各组的基线临床特征、造影结果、30天、6个月心血管结局和3年死亡率。
共有836例符合纳入标准。造影时间>2天的患者三支血管病变发生率更高（45.7%对31.7%，p<0.001），造影时接受经皮介入治疗的比例更低（41.6%对56.7%，p<0.001），冠状动脉搭桥手术更频繁（9.9%对15.3%，p=0.05）。在调整混杂变量后，接受延迟有创风险分层（>2天）的患者3年死亡率增加（OR 2.12，95%CI 1.03-4.35，p=0.04）。
在无造影禁忌证的NSTE-ACS患者中，发病后延迟超过2天进行造影与3年死亡率增加相关。
