Riezebos R K, Ronner E, Ter Bals E, Slagboom T, Smits P C, ten Berg J M, Kiemeneij F, Amoroso G, Patterson M S, Suttorp M J, Tijssen J G P, Laarman G J
Onze Lieve Vrouwe Gasthuis, Department of Interventional Cardiology, Amsterdam, The Netherlands.
Heart. 2009 May;95(10):807-12. doi: 10.1136/hrt.2008.154815. Epub 2008 Dec 19.
The field of acute coronary syndromes is characterised by an increasing tendency towards early invasive catheter-based diagnostics and therapeutics-a practice based on observational and retrospective data.
To compare immediate versus deferred angioplasty in patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) METHODS: A randomised, prospective multicentre trial was performed in patients admitted with NSTE-ACS, eligible for percutaneous coronary intervention (PCI). Interim analysis was performed after enrolment of 251 patients; PCI was appropriate in 142 patients. These patients were randomised to immediate PCI (n = 73) or deferred PCI (24-48 h) (n = 69). Patients received protocol-driven glycoprotein IIb/IIIa blockers, aspirin and clopidogrel. The primary end point was a composite of death, non-fatal myocardial infarction (MI) or unplanned revascularisation, at 30 days. After hospital discharge outpatient follow-up was performed at 30 days and 6 months.
The incidence at 30 days of the primary end point was 60% in the group receiving immediate PCI and 39% in the group receiving deferred PCI (relative risk (RR) = 1.5, 95% CI 1.09 to 2.15; p = 0.004). No deaths occurred in either group. MI was significantly more common in the group receiving immediate PCI (60% vs 38%, RR = 1.6, 95% CI 1.12 to 2.28, p = 0.005). Unplanned revascularisation was similar in both groups. The observed difference was preserved over 6-months' follow-up.
Immediate PCI was associated with an increased rate of MI in comparison with a 24-48 h deferred strategy, despite aggressive antithrombotic treatment. The results suggest that PCI for high-risk patients with non-refractory NSTE-ACS should be delayed for at least 24 h after hospital admission.
ISRCTN80874637.
急性冠状动脉综合征领域的特点是基于观察性和回顾性数据，早期侵入性导管诊断和治疗的趋势日益增加。
比较非ST段抬高型急性冠状动脉综合征（NSTE-ACS）患者即刻血管成形术与延迟血管成形术的效果。
对因NSTE-ACS入院且适合经皮冠状动脉介入治疗（PCI）的患者进行了一项随机、前瞻性多中心试验。在纳入251例患者后进行中期分析；142例患者适合进行PCI。这些患者被随机分为即刻PCI组（n = 73）或延迟PCI组（24 - 48小时）（n = 69）。患者接受方案驱动的糖蛋白IIb/IIIa阻滞剂、阿司匹林和氯吡格雷治疗。主要终点是30天时死亡、非致命性心肌梗死（MI）或非计划血管重建的复合终点。出院后在30天和6个月时进行门诊随访。
即刻PCI组30天时主要终点的发生率为60%，延迟PCI组为39%（相对风险（RR）= 1.5，95%可信区间1.09至2.15；p = 0.004）。两组均未发生死亡。MI在即刻PCI组明显更常见（60%对38%，RR = 1.6，95%可信区间1.12至2.28，p = 0.005）。两组非计划血管重建情况相似。观察到的差异在6个月的随访中持续存在。
尽管进行了积极的抗血栓治疗，但与24 - 48小时延迟策略相比，即刻PCI与MI发生率增加相关。结果表明，对于非难治性NSTE-ACS的高危患者，PCI应在入院后至少延迟24小时。
ISRCTN80874637。
