Naidu Srihari S, Polin Glenn M, Selzer Faith, Laskey Warren K, Jacobs Alice K, Williams David O, Wilensky Robert L
The Cardiovascular Division, Weill Cornell Medical Center, New York, New York, USA.
Am J Cardiol. 2006 Aug 15;98(4):447-52. doi: 10.1016/j.amjcard.2006.03.021. Epub 2006 Jun 19.
Percutaneous coronary intervention (PCI) for unstable angina pectoris (UAP) has traditionally been associated with a higher risk of ischemic complications than that for stable angina pectoris (SAP). However, PCI procedures have evolved, so this study was designed to determine whether PCI for UAP is still associated with less favorable outcomes. In-hospital and 1-year outcomes in Dynamic Registry patients who presented for PCI with UAP (n = 2,994) or SAP (n = 1,457) between 1997 and 2002 were compared. One-year results were also compared with consecutive patients who underwent angioplasty (n = 2,431) from the 1985 to 1986 Percutaneous Transluminal Coronary Angioplasty Registry. Although Dynamic Registry patients with UAP were older and more likely to smoke (p < 0.05), have diabetes mellitus (p = 0.03), or a previous myocardial infarction (p < 0.001), procedural success was higher than in patients with SAP. By 1 year, there was greater risk of death (4.4% vs 2.6%, p < 0.01), death/myocardial infarction (9.9% vs 6.6%, p < 0.001), and death, myocardial infarction, and coronary artery bypass grafting (15.1% vs 11.6%, p < 0.01) in patients with UAP. In patients with UAP, there was no significant difference in adjusted 1-year death and death/myocardial infarction rates when comparing the waves of the Dynamic Registry with those of the Percutaneous Transluminal Coronary Angioplasty Registry, although death/myocardial infarction rates among Dynamic Registry patients were lower. However, in patients with SAP, the adjusted rate for death/myocardial infarction was lower in wave 3, and for death, myocardial infarction, and revascularization, there was a significant decrease in event rates with each successive recruitment period (p < 0.05 for all comparisons). In conclusion, in contradistinction to patients with SAP, death and death/myocardial infarction rates in patients who have undergone PCI for UAP have not significantly decreased over the past 16 years and patients with UAP remain at a greater risk of ischemic events at 1 year compared with patients with SAP.
传统上，与稳定型心绞痛（SAP）相比，经皮冠状动脉介入治疗（PCI）用于不稳定型心绞痛（UAP）时缺血并发症风险更高。然而，PCI技术不断发展，因此本研究旨在确定UAP患者接受PCI治疗是否仍与较差的预后相关。对1997年至2002年间因UAP（n = 2,994）或SAP（n = 1,457）前来接受PCI治疗的动态注册研究患者的院内及1年预后进行了比较。还将1年结果与1985年至1986年经皮腔内冠状动脉成形术注册研究中连续接受血管成形术的患者（n = 2,431）进行了比较。尽管动态注册研究中UAP患者年龄更大，更有可能吸烟（p < 0.05）、患有糖尿病（p = 0.03）或有过心肌梗死（p < 0.001），但其手术成功率高于SAP患者。到1年时，UAP患者的死亡风险（4.4%对2.6%，p < 0.01）、死亡/心肌梗死风险（9.9%对6.6%，p < 0.001）以及死亡、心肌梗死和冠状动脉旁路移植术风险（15.1%对11.6%，p < 0.01）更高。在UAP患者中，将动态注册研究各阶段与经皮腔内冠状动脉成形术注册研究各阶段相比，调整后的1年死亡和死亡/心肌梗死发生率无显著差异，尽管动态注册研究患者中的死亡/心肌梗死发生率较低。然而，在SAP患者中，第3阶段的死亡/心肌梗死调整率较低，对于死亡、心肌梗死和血运重建，随着每个连续招募期事件发生率显著降低（所有比较p < 0.05）。总之，与SAP患者不同，过去16年中接受PCI治疗的UAP患者的死亡和死亡/心肌梗死发生率并未显著降低，与SAP患者相比，UAP患者在1年时发生缺血事件的风险仍然更高。
