Mehta Rajendra H, Greenbaum Adam B, Lokhnygina Yuliya, Newby L Kristin, Van De Werf Frans, Armstrong Paul W, Pieper Karen S, Califf Robert M, Granger Christopher B, Harrington Robert A
Duke Clinical Research Institute, Durham, NC 27715, USA.
J Interv Cardiol. 2007 Oct;20(5):299-306. doi: 10.1111/j.1540-8183.2007.00277.x.
Adverse events occur following non-ST elevation acute coronary syndromes (NSTE ACS). However, the timing of these events in relation to index event is less clear.
Accordingly, we evaluated 26,466 NSTE ACS patients from the Global Use of Strategies to Open Occluded Arteries in Acute Coronary Syndromes (GUSTO-IIb), Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT), and Platelet IIb/IIIa Antagonism for the Reduction of Acute Coronary Syndrome Events in a Global Organization Network (PARAGON) A and B trials to ascertain the timing of adverse events. Outcomes of interest were death, myocardial infarction (MI), and death or MI at 180 days. Logistic regression modeling for death was used to categorize patients into low-, medium-, and high-risk groups.
At 6 months, 6.2% of patients died, 12.1% had MI, and 15.7% suffered death or MI. From 15% to 40% of these events occurred beyond 30 days. At 6 months, 3%, 4%, and 13% of patients died in low-, medium-, and high-risk groups, respectively. However, the proportion of patients dying beyond 30 days was similar in the three groups (44%, 43%, and 41% of death, respectively). Similarly, whereas death or MI increased with higher risk (11%, 14%, and 23%, respectively), the proportion of patients with this event beyond 30 days did not differ in the three strata (22%, 20%, and 25%, respectively).
Our study provides important insights into the timing of adverse events and suggests that the substantial proportion of patients suffer subsequent adverse events after their index NSTE ACS. Thus, these data call for continuous surveillance for these events and efforts beyond the acute phase at increasing adherence to evidence-based therapies to improve the outcomes of these patients.
非ST段抬高型急性冠状动脉综合征（NSTE ACS）后会发生不良事件。然而，这些事件相对于索引事件的发生时间尚不清楚。
因此，我们评估了来自急性冠状动脉综合征中全球使用开放闭塞动脉策略（GUSTO-IIb）、不稳定型心绞痛中血小板糖蛋白IIb/IIIa：使用依替巴肽治疗的受体抑制（PURSUIT）以及全球组织网络中血小板IIb/IIIa拮抗剂用于减少急性冠状动脉综合征事件（PARAGON）A和B试验的26466例NSTE ACS患者，以确定不良事件的发生时间。感兴趣的结局是180天时的死亡、心肌梗死（MI）以及死亡或MI。使用死亡的逻辑回归模型将患者分为低、中、高风险组。
在6个月时，6.2%的患者死亡，12.1%发生MI，15.7%出现死亡或MI。这些事件中有15%至40%发生在30天之后。在6个月时，低、中、高风险组分别有3%、4%和13%的患者死亡。然而，三组中30天之后死亡的患者比例相似（分别为死亡患者的44%、43%和41%）。同样，虽然死亡或MI随着风险升高而增加（分别为11%、14%和23%），但该事件在30天之后的患者比例在三个分层中并无差异（分别为22%、20%和25%）。
我们的研究为不良事件的发生时间提供了重要见解，并表明相当一部分患者在其索引NSTE ACS后会发生后续不良事件。因此，这些数据呼吁对这些事件进行持续监测，并在急性期之后努力提高对循证治疗的依从性，以改善这些患者的结局。
