Szyguła-Jurkiewicz Bozena, Wasilewski Jarosław, Wilczek Krzysztof, Osadnik Tadeusz, Trzeciak Przemysław, Lekston Andrzej, Wojnicz Romuald, Poloński Lech
Z III Katedry i Oddzialu Klinicznego Kardiologii Slaskiej Akademii Medycznej, Katowicach Slaskie Centrum Chorób Serca, Zabrzu.
Wiad Lek. 2006;59(7-8):497-501.
We aimed at assessing the frequency of death, myocardial infarction, unstable angina, repeat revascularization, cardiovascular hospitalisation during 12 months in patients assigned to early invasive strategy.
We analysed 658 consecutive patients with acute coronary syndrome (ACS) without ST-segment elevation hospitalized between January 2000 and February 2003. Patients had to fulfill the following criteria: 1) rest angina within 24 hours prior to admission, 2) at least one of the following: ST-segment depression (> or = 0,05 mV), transient (< 20 min) ST-segment elevation (> or = 0,05 mV), T-wave inversion (> or = 1 mV) in at least 2 contiguous leads, positive serum cardiac markers.
All patients underwent coronary angiography followed by PCI (percutaneous coronary interventions) in 71.8% of patients. 18.2% were assigned to CABG (coronary artery bypass graft) and 8.7% of patients were treated conservatively. 1.3% of patients underwent PCI followed by an elective CABG surgery. In-hospital mortality rate was.,3%. 3.3% patients died after hospital discharge. The frequency of myocardial infarction, unstable angina and repeat PCI at 12 months was 2.1%, 16.8% and 11.5% respectively. The rate of cardiovascular hospitalisation was 15.6%. Multivariate analysis identified two independent predictors ofdeath: diabetes mellitus (OR: 7.02, 95% CI: 1.5-13.8, p = 0.03) and heart failure (OR: 12.6, 95% CI: 2.86-16.6 p = 0.005).
Early invasive strategy in analysed group yields good long-term outcomes with low rate of adverse ischemic events. Independent predictors of deaths were diabetes mellitus and heart failure.
我们旨在评估采用早期侵入性策略的患者在12个月内的死亡、心肌梗死、不稳定型心绞痛、再次血运重建及心血管住院治疗的发生率。
我们分析了2000年1月至2003年2月期间连续收治的658例无ST段抬高的急性冠状动脉综合征（ACS）患者。患者必须符合以下标准：1）入院前24小时内静息性心绞痛；2）至少具备以下一项：ST段压低（≥0.05 mV）、短暂性（<20分钟）ST段抬高（≥0.05 mV）、至少2个相邻导联T波倒置（≥1 mV）、血清心肌标志物阳性。
所有患者均接受了冠状动脉造影，71.8%的患者随后接受了经皮冠状动脉介入治疗（PCI）。18.2%的患者接受冠状动脉旁路移植术（CABG），8.7%的患者接受保守治疗。1.3%的患者先接受PCI，随后接受择期CABG手术。住院死亡率为0.3%。出院后3.3%的患者死亡。12个月时心肌梗死、不稳定型心绞痛及再次PCI的发生率分别为2.1%、16.8%和11.5%。心血管住院率为15.6%。多因素分析确定了两个死亡的独立预测因素：糖尿病（比值比：7.02，95%可信区间：1.5 - 13.8，p = 0.03）和心力衰竭（比值比：12.6，95%可信区间：2.86 - 16.6，p = 0.005）。
分析组中的早期侵入性策略产生了良好的长期预后，不良缺血事件发生率较低。死亡独立预测因素为糖尿病和心力衰竭。
